Differential Diagnosis for a 9-year-old with String-like Objects in Stool
- Single most likely diagnosis
- Enterobiasis (pinworm infection): This is the most likely diagnosis due to the presence of string-like objects in the stool, which are likely pinworms. The patient's symptoms of lower abdominal discomfort and the presence of visible parasites in the family cat's stool also support this diagnosis. Pinworms are common in children and can be transmitted through contact with contaminated feces or by ingesting food contaminated with pinworm eggs.
- Other Likely diagnoses
- Hookworm infection: Although less common, hookworm infection could also present with similar symptoms, including abdominal discomfort and the presence of worms in the stool. However, hookworms are typically acquired through contact with contaminated soil, which is not mentioned in the patient's history.
- Tapeworm infection: Tapeworms can also cause abdominal discomfort and may be visible in the stool. However, the patient's history of no recent travel outside the United States and no consumption of uncooked food makes this diagnosis less likely.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed)
- Intussusception: Although rare, intussusception is a life-threatening condition that can cause abdominal pain and the passage of a "string-like" object, which may be a portion of the intestine. It is essential to consider this diagnosis, especially if the patient's symptoms worsen or if there is evidence of intestinal obstruction.
- Gastrointestinal malignancy: Although extremely rare in children, gastrointestinal malignancies such as lymphoma or colon cancer can cause abdominal pain and changes in bowel habits. It is crucial to consider these diagnoses if the patient's symptoms persist or worsen despite treatment for more common conditions.
- Rare diagnoses
- Ascariasis (roundworm infection): Although roundworms can cause abdominal discomfort and may be visible in the stool, this diagnosis is less likely due to the patient's history of no recent travel outside the United States and no consumption of uncooked food.
- Trichuriasis (whipworm infection): Whipworms can cause abdominal discomfort and may be visible in the stool, but this diagnosis is relatively rare in the United States and typically requires exposure to contaminated soil or food.