Differential Diagnosis for 79-year-old Female with Left Lower Abdominal Pain and Diarrhea
- Single most likely diagnosis:
- Diverticulitis: Given the patient's age, history of bowel resection, and presentation of severe left lower abdominal pain associated with diarrhea, diverticulitis is a strong consideration. The presence of rebound pain and the severity of the pain (10 out of 10) also support this diagnosis.
- Other Likely diagnoses:
- Small bowel obstruction: The patient's history of bowel resection and current symptoms of abdominal pain, diarrhea, and rebound pain could suggest a small bowel obstruction, especially if adhesions from previous surgeries are considered.
- Colitis (infectious or inflammatory): The onset of diarrhea and abdominal pain could indicate colitis, either from an infectious cause or an inflammatory process, especially given the patient's age and history of bowel surgery.
- Adhesional band or internal hernia: Given the patient's surgical history, adhesional bands or an internal hernia causing bowel obstruction or ischemia is a plausible diagnosis.
- Do Not Miss (ddxs that may not be likely, but would be deadly if missed.):
- Bowel ischemia or infarction: This condition is critical and requires immediate attention. The patient's symptoms of severe abdominal pain and diarrhea, combined with a history of bowel resection, make this a diagnosis that cannot be missed.
- Perforated viscus: The presence of rebound pain and severe abdominal pain suggests the possibility of a perforated viscus, which is a surgical emergency.
- Appendicitis (if the appendix was not completely removed during the appendectomy): Although less likely given the patient's history of appendectomy, if any appendix tissue remains, appendicitis could still occur.
- Rare diagnoses:
- Meckel's diverticulitis: A rare condition where a congenital diverticulum of the small intestine becomes inflamed, which could present with abdominal pain and diarrhea.
- Intussusception: A condition where a part of the intestine telescopes into another part, which can cause abdominal pain and changes in bowel habits, although it is more common in children.
- Neoplastic processes (e.g., colon cancer): While less likely to present acutely, a new onset of symptoms in an elderly patient could potentially be related to a neoplastic process, especially if there's a change in bowel habits or abdominal pain.