Acute abdominal pain in a boy with cystic fibrosis

Abstract

A 10 year old boy presented to the emergency department with a 24 hour history of abdominal pain in a colicky pattern; nausea; and bilious and faecal vomiting. His history included well controlled cystic fibrosis with pancreatic insufficiency and a meconium ileus in the neonatal period, which was treated surgically. He passed his last stools the night before presentation. In the previous days he had passed stools once daily. His drug regimen included pancreatin (pancreatic enzymes), omeprazole, vitamin A, D, E, and K supplements, and hypertonic saline inhalations. On physical examination the boy was uncomfortable and had a distended abdomen with minimal peristalsis. There was tenderness across the whole abdomen and a positive rebound response without guarding or other signs of peritonitis. His body temperature was normal. Laboratory results showed a white blood cell count of 8.8 × 109/L (normal range 4.5-13.0) with normal differential count, platelet count 278 × 109/L (normal range 120-350), C reactive protein 10 mg/L (normal range <10). Serum values for electrolytes, liver and pancreatic enzymes, urea, and creatinine were normal. On ultrasonography an abrupt change in bowel calibre was seen and an upright abdominal radiograph was obtained (fig 1⇓).