BACKGROUND
A 2-year-old girl presents to the pediatric emergency department because of epigastric abdominal pain for the last 3 days associated with fever; vomiting; and watery, brown stools. Her parents deny hematemesis or blood in her stool.
The episodic symptoms cause the patient to double over in pain and have been increasing in frequency, now occurring every 20 minutes. The patient vomits after every feeding, including liquid feedings, and her last bowel movement occurred 24 hours prior to her admission. She was evaluated 2 days ago for similar complaints and discharged home with a diagnosis of gastroenteritis.
The patient has a normal birth history, no medical problems, and no prior surgeries. Her immunizations are current.
On physical examination, the girl's vital signs are as follows: rectal temperature, 100.2°F; pulse, 134 beats per minute; respirations, 32 breaths per minute; and oxygen saturation with pulse oximetry, 98% on room air.
The patient is alert and sitting comfortably with her parents. Her skin and mucous membranes are moist. The remaining findings are normal and reveal a soft, nontender, nondistended abdomen without rebound or guarding. Rectal examination is not performed.
While you speak to the parents, the patient clutches her abdomen and cries, doubling over in pain. The episode spontaneously resolves after several minutes. What is the diagnosis?
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Hint
Note the episodic abdominal pain and positive radiographic findings.
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Author:
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Chilembwe Mason, MD, Staff Physician, Department of Emergency Medicine, St Luke's-Roosevelt Hospital Center, and In-Hei Hahn, MD, Assistant Director of Research, Department of Emergency Medicine, St Luke's-Roosevelt Hospital Center, Assistant Clinical Professor, Department of Medicine, University Hospital of Columbia University College of Physicians and Surgeons
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St Luke's-Roosevelt Hospital Center Department of Emergency Medicine
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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
