Differential Diagnosis for Patient with High Neutrophilia, Epigastric/Periumbilical Pain, and Imaging Showing Gas in Small Bowel

• Single Most Likely Diagnosis
  • Small Bowel Obstruction: This condition is characterized by the blockage of the small intestine, which can lead to severe abdominal pain, vomiting, and constipation. The presence of high neutrophilia suggests an inflammatory or infectious process, and imaging showing gas in the small bowel is consistent with obstruction. The epigastric/periumbilical pain is also typical for this condition.
• Other Likely Diagnoses
  • Mesenteric Ischemia: This condition involves insufficient blood flow to the intestines, leading to tissue damage. It can cause severe abdominal pain, and imaging may show gas in the bowel wall or portal venous system. Neutrophilia can be present due to the inflammatory response to ischemia.
  • Appendicitis with Small Bowel Involvement: Although appendicitis typically presents with pain in the right lower quadrant, it can sometimes involve the small bowel and cause more generalized abdominal pain. High neutrophilia is common in appendicitis due to the significant inflammatory response.
  • Diverticulitis: This condition involves inflammation of the diverticula in the intestinal wall, which can cause abdominal pain, changes in bowel habits, and elevated white blood cell count. While it more commonly affects the colon, diverticulitis can occur in the small bowel (Meckel's diverticulum) and present similarly.
• Do Not Miss Diagnoses
  • Perforated Visus: A perforation in the gastrointestinal tract can lead to peritonitis, an infection of the abdominal cavity, which is life-threatening. The presence of free air in the abdomen on imaging and severe abdominal pain are key indicators. High neutrophilia would be expected due to the severe infection.
  • Intra-abdominal Sepsis: This condition involves a severe infection within the abdominal cavity, which can arise from various sources, including perforated viscous, abscesses, or infected pancreatic necrosis. It is critical to identify and treat promptly to prevent high mortality.
• Rare Diagnoses
  • Intussusception in Adults: Although more common in children, intussusception (the telescoping of one segment of intestine into another) can occur in adults and cause bowel obstruction. It might present with abdominal pain, vomiting, and alterations in bowel habits, along with imaging findings of a "target sign" or "coiled spring appearance."
  • Eosinophilic Gastroenteritis: This rare condition involves an eosinophilic infiltration of the gastrointestinal tract, leading to various symptoms, including abdominal pain, diarrhea, and sometimes intestinal obstruction. However, it typically does not present with high neutrophilia but rather with eosinophilia.