Differential Diagnosis for Abdominal Pain in a 22-year-old Woman
- Single most likely diagnosis:
- Sickle cell crisis: The patient has a history of sickle cell disease and is experiencing severe abdominal pain that is not relieved by her usual dose of hydrocodone. The pain is constant and has worsened over time, which is consistent with a sickle cell crisis.
- Other Likely diagnoses:
- Pregnancy-related complications (e.g., threatened abortion, placental abruption): Although the pelvic ultrasonography reveals a normal intrauterine pregnancy, the patient's abdominal pain and enlarged uterus could be related to pregnancy-related complications.
- Urinary tract infection or pyelonephritis: Although the patient reports no change in bowel or bladder patterns, a urinary tract infection could cause abdominal pain and should be considered.
- Ovarian torsion or other adnexal pathology: Although Doppler imaging demonstrates normal adnexal blood flow, ovarian torsion or other adnexal pathology could still be present and cause abdominal pain.
- Do Not Miss diagnoses:
- Ectopic pregnancy: Although the pelvic ultrasonography reveals an intrauterine pregnancy, an ectopic pregnancy could still be present, especially given the patient's history of multiple sexual partners and potential for undiagnosed sexually transmitted infections.
- Appendicitis: Appendicitis is a life-threatening condition that requires prompt surgical intervention. Although the patient's symptoms are not typical for appendicitis, it should still be considered in the differential diagnosis.
- Ruptured ovarian cyst: A ruptured ovarian cyst could cause severe abdominal pain and should be considered, especially given the patient's age and sex.
- Rare diagnoses:
- Abdominal vasculitis: Vasculitis affecting the abdominal vessels could cause abdominal pain and should be considered in patients with a history of autoimmune disorders or other vasculitic conditions.
- Intra-abdominal malignancy: Although rare in young women, intra-abdominal malignancy could cause abdominal pain and should be considered in the differential diagnosis, especially if other causes are ruled out.