BACKGROUND
A 15-month-old girl presents to the emergency department with vomiting and a fever. Her parents also report that she has had intermittent crying followed by episodes of projectile nonbilious emesis. She appeared comfortable and playful after these episodes. At home, her temperature was 102°F (39°C); however, now she is afebrile. She appears sleepy but is arousable. Her heart rate is 130 beats per minute, and her respiratory rate is 32 breaths per minute. Her lips and oral mucosa are dry. Her abdomen is soft and nondistended. She has mild tenderness in her right upper quadrant and scant bowel sounds. No masses or hernias are noted. Rectal examination findings are normal. The patient's stool shows no fecal occult blood.
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Hint
The patient has a paucity of bowel gas.
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Author:
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Muhammad Waseem, MD
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Assistant Professor of Emergency Medicine, Weill Medical College of Cornell University; Consulting Staff, Department of Emergency Medicine, Lincoln Medical and Mental Health Center
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eMedicine Editor:
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Sat Sharma, MD
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Associate Professor, University of Manitoba, Department of Medicine, Division of Pulmonary Medicine
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eMedicine Case
