Differential Diagnosis
- Single most likely diagnosis
- Ileus: The presence of air-fluid levels throughout the small bowel and colon, along with mild distension of the proximal colon, is highly suggestive of an ileus. Ileus is a condition where there is a temporary halt of the normal contractions of the bowel muscles, leading to a buildup of food, fluids, and gas.
- Other Likely diagnoses
- Mechanical obstruction: The findings could also represent a mechanical obstruction, especially given the mention of an area of narrowing in the sigmoid colon. This could be due to various causes such as adhesions, hernias, or tumors.
- Constipation/Fecal impaction: The large amount of stool in the distal colon suggests constipation or fecal impaction, which could be contributing to the observed findings, especially if there is an underlying issue with bowel motility or if the patient has not had a bowel movement recently.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Bowel ischemia: Although not directly suggested by the findings, bowel ischemia (reduced blood flow to the intestines) can lead to ileus or obstruction and is a potentially life-threatening condition that requires prompt diagnosis and treatment.
- Volvulus: A twisting of a portion of the intestine, which can lead to obstruction and ischemia. It's a serious condition that might not be immediately apparent from the described findings but could be a cause of the observed symptoms.
- Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially causing obstruction. It's more common in children but can occur in adults, often with a lead point such as a tumor.
- Rare diagnoses
- Chronic intestinal pseudo-obstruction: A rare condition characterized by recurrent episodes of intestinal obstruction without any physical blockage. It could present with similar radiographic findings and is due to a problem with the muscle contractions that move food, fluid, and air through the intestines.
- Hirschsprung's disease (in adults): Although typically diagnosed in infancy, Hirschsprung's disease can rarely present in adults, leading to chronic constipation and potentially to findings similar to those described, due to the absence of ganglion cells in the distal bowel.