Differential Diagnosis
The patient's presentation is complex, with multiple findings from laboratory tests and imaging studies. The differential diagnosis can be organized into the following categories:
- Single Most Likely Diagnosis
- Gastrointestinal Obstruction: The patient's abdominal ultrasound and X-ray findings suggest ileus and possible partial intestinal obstruction. The prominent stomach size and ileus are consistent with a gastrointestinal obstruction, which could be due to various causes such as adhesions, hernias, or tumors.
- Other Likely Diagnoses
- Gastroenteritis: The patient's elevated white blood cell count (WBC) and neutrophil percentage (NEUTRO) could indicate an infectious process such as gastroenteritis, which could also contribute to the ileus.
- Constipation: The patient's fecal retention and ileus could be related to constipation, which is common in elderly patients.
- Pancreatitis: Although the pancreas is obscured by overlying bowel gas on the ultrasound, pancreatitis is a possible diagnosis given the patient's abdominal symptoms and ileus.
- Do Not Miss Diagnoses
- Bowel Ischemia: This is a potentially life-threatening condition that could present with similar symptoms and findings, including ileus and abdominal pain. It is essential to consider this diagnosis to avoid missing a critical condition.
- Perforated Viscus: A perforated viscus is a surgical emergency that could present with ileus, abdominal pain, and free intraperitoneal fluid. Although the X-ray does not show free air, it is crucial to consider this diagnosis.
- Sepsis: The patient's elevated WBC and neutrophil percentage could indicate sepsis, which is a life-threatening condition that requires prompt recognition and treatment.
- Rare Diagnoses
- Mesenteric Panniculitis: This is a rare condition characterized by inflammation of the mesenteric fat, which could present with abdominal pain, ileus, and bowel obstruction.
- Amyloidosis: This is a rare condition that could affect the gastrointestinal tract and present with symptoms such as ileus, abdominal pain, and bowel obstruction.
- Neurogenic Bowel: This is a rare condition that could present with ileus, constipation, and abdominal pain, particularly in patients with underlying neurological conditions.