Differential Diagnosis for Lower Abdominal Pain
Single Most Likely Diagnosis
- Diverticulitis: Given the lower abdominal pain and elevated white blood cell count (WBC) with a high absolute neutrophil count, diverticulitis is a strong consideration. The absence of bowel obstruction features on the X-ray and the presence of mild colonic fecal retention do not rule out this diagnosis, as diverticulitis can present with a range of symptoms and findings.
Other Likely Diagnoses
- Appendicitis: Although the X-ray does not show signs of bowel obstruction, appendicitis can cause lower abdominal pain and an elevated WBC count. The location of the pain and the laboratory findings make this a plausible diagnosis.
- Gastroenteritis: The elevated WBC count and mild colonic fecal retention could also suggest a gastrointestinal infection. However, the bilirubin level is slightly elevated, which might not typically be seen in simple gastroenteritis.
- Inflammatory Bowel Disease (IBD) Flare: Conditions like Crohn's disease or ulcerative colitis can present with abdominal pain, elevated WBC, and changes in bowel habits. The absence of specific radiographic findings does not rule out an IBD flare.
Do Not Miss Diagnoses
- Ectopic Pregnancy: In women of childbearing age, ectopic pregnancy is a critical diagnosis to consider with lower abdominal pain, even with a normal abdominal X-ray. The elevated WBC could be seen in ectopic pregnancy due to associated inflammation or infection.
- Ovarian Torsion: This is another emergency condition that can present with severe lower abdominal pain. While the X-ray does not show specific findings, ovarian torsion requires prompt diagnosis and treatment.
- Intestinal Ischemia: Although less common, intestinal ischemia can present with abdominal pain and elevated WBC. The absence of bowel obstruction on X-ray does not rule out this diagnosis, as ischemia can occur without obstruction.
Rare Diagnoses
- Yersinia or Other Atypical Infections: Certain bacterial infections can cause abdominal pain and elevated WBC counts. These are less common but should be considered, especially if more typical diagnoses are ruled out.
- Neoplastic Processes: Although rare, abdominal pain and elevated WBC can be seen in the context of malignancies affecting the abdomen, such as lymphoma or gastrointestinal cancers. The slightly elevated bilirubin could suggest liver involvement.
- Intra-abdominal Abscess: An abscess within the abdominal cavity can cause pain, fever, and an elevated WBC count. This could be a complication of another condition like diverticulitis or appendicitis.