Differential Diagnosis for Post-Gastrectomy Patient
The patient's presentation of elevated WBCs, normal NGT, and a drain output of 150 ml with a soft and lax abdomen 3 days after gastrectomy with Roux en Y gastrojejunostomy suggests an infectious or inflammatory process. Here's a categorized differential diagnosis:
- Single Most Likely Diagnosis
- A. Duodenal stump blow out: This condition is a known complication after gastrectomy, especially if the duodenal stump closure is insecure. The elevated WBC count and the presence of drain output could indicate leakage from the duodenal stump, which is a serious condition requiring prompt intervention.
- Other Likely Diagnoses
- B. Jejunal leakage: Although less common than duodenal stump leakage, a leak from the jejunojejunostomy site could also lead to elevated WBCs and drain output. The clinical presentation would be similar, making differentiation based on symptoms alone challenging.
- C. Jejunojejunostomy: Issues at the jejunojejunostomy site, such as leakage or stenosis, could also lead to increased WBC counts and changes in drain output. However, the presence of a soft and lax abdomen might make this less likely compared to a duodenal stump issue.
- Do Not Miss Diagnoses
- D. Oesophagojejunal leak: Although less likely given the normal NGT, an oesophagojejunal leak is a potentially catastrophic complication that must be considered, especially if there are any signs of sepsis or peritonitis. The consequences of missing this diagnosis could be severe.
- Rare Diagnoses
- Other rare complications such as intra-abdominal abscess, pancreatic fistula, or hollow viscus injury could also present with similar symptoms but are less likely given the information provided. These conditions would typically require additional specific findings or a failure to respond to initial management for duodenal stump or jejunal issues.
Each of these diagnoses requires careful consideration of the patient's clinical presentation, laboratory results, and potentially, additional imaging studies to confirm the diagnosis and guide appropriate management.