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, with signs of peritonitis or sepsis.
- C. Jejunojejunostomy: Issues at the jejunojejunostomy site, such as leakage or stenosis, could also lead to similar symptoms, though the timing and nature of the symptoms might vary.
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. Early detection is crucial for management.
- Intra-abdominal abscess: Not listed among the options but critical to consider, an intra-abdominal abscess could form as a complication of any surgical site infection or leakage, leading to elevated WBCs and potentially severe consequences if not promptly addressed.
Rare Diagnoses
- Other infections: Rarely, other post-surgical infections (e.g., pneumonia, urinary tract infections) could cause elevated WBCs. However, these would typically be accompanied by other specific symptoms and signs.
- Pancreatic fistula: If the patient had any pancreatic injury during surgery, a pancreatic fistula could be a rare but serious complication, potentially leading to elevated WBCs among other symptoms.
Each of these diagnoses requires careful consideration of the patient's clinical presentation, laboratory results, and imaging studies to determine the most appropriate course of action.