Differential Diagnosis for a 64M with History of Laparoscopic Extralevator APR in 2015 and Perianal Sinus Excision in 2019
- Single Most Likely Diagnosis
- Chronic pain or discomfort at the site of previous surgeries: This is likely due to the history of surgeries, which can lead to adhesions, scar tissue, or nerve damage causing ongoing pain.
- Other Likely Diagnoses
- Recurrence of perianal sinus or fistula: Given the history of perianal sinus excision, there's a possibility of recurrence, especially if the initial surgery was not fully successful.
- Bowel obstruction: Adhesions from previous surgeries can lead to bowel obstruction, presenting with symptoms like abdominal pain, nausea, vomiting, and constipation.
- Abscess formation: The history of surgeries in the perianal and abdominal regions increases the risk of abscess formation, which could be a complication of the previous surgeries.
- Do Not Miss Diagnoses
- Malignancy (recurrence or new primary): Although less likely, it's crucial not to miss a potential malignancy, especially given the patient's history of APR, which is often performed for cancer.
- Sepsis: Any sign of infection, especially in a post-surgical patient, should prompt consideration of sepsis, a life-threatening condition requiring immediate intervention.
- Necrotizing fasciitis: A rare but deadly infection that could occur post-surgically, especially in areas with compromised blood supply or in diabetic patients.
- Rare Diagnoses
- Enterocutaneous fistula: A possible complication of previous abdominal surgeries, where there's an abnormal connection between the intestine and the skin.
- Pilonidal sinus: Although the patient had a perianal sinus excision, a pilonidal sinus could occur, especially if there's a history of similar conditions or if the initial surgery was not fully successful.
- Foreign body reaction: If any foreign material was left during the surgeries, it could lead to a chronic inflammatory reaction or infection.