Differential Diagnosis
- Single most likely diagnosis
- Adynamic ileus: This condition is characterized by a temporary cessation of the normal contractions of the bowel muscles, leading to bowel obstruction symptoms without any physical blockage. The patient's history of alcohol use disorder and the presence of severe nausea, vomiting, abdominal distention, and passing small amounts of flatus, along with radiographic findings of dilated loops of small bowel without a transition point, are consistent with this diagnosis. Alcohol use can lead to adynamic ileus due to its toxic effects on the bowel muscles.
- Other Likely diagnoses
- Mechanical small bowel obstruction: Although the radiograph does not show a transition point, partial or early obstruction could still be a consideration, especially if the patient's symptoms worsen or if further imaging is obtained.
- Gastroenteritis: Inflammation of the gastrointestinal tract could cause the patient's symptoms, especially if the cause is viral or related to alcohol use.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.)
- Mesenteric ischemia: This condition involves insufficient blood flow to the intestines and can present with severe abdominal pain out of proportion to physical findings, nausea, vomiting, and abdominal distention. It is a medical emergency requiring prompt diagnosis and treatment.
- Perforated viscus: A hole in the wall of the stomach or intestine can lead to severe abdominal pain, nausea, vomiting, and abdominal distention. It is a surgical emergency.
- Rare diagnoses
- Intussusception: A condition where a part of the intestine slides into an adjacent part, potentially causing bowel obstruction. It is rare in adults and usually associated with a lead point such as a tumor.
- Volvulus: A twisting of a portion of the intestine that can cut off blood flow and require emergency surgery. It might present with symptoms similar to those described but is less common than other causes of bowel obstruction.