Case 3: Abdominal Pain and Vomiting in a 4-Year-Old Boy

Abstract

1. Chari D. Larsen, MD* 2. Marta A. King, MD, MEd† 1. *Pediatric Residency Program, University of Utah, Salt Lake City, UT. 2. †Department of Pediatrics, St Louis University School of Medicine, St Louis, MO. A previously healthy 4-year-old boy presents to his pediatrician’s office with acute onset of abdominal pain and vomiting. Pain began suddenly the night before presentation. The pain is intermittent and severe, lasts a few seconds at a time, and prevents the child from sleeping. Nonbloody, nonbilious vomiting started approximately 3 hours after the onset of the pain. He has had more than 20 episodes of emesis and is unable to keep down fluids. The family denies the patient had fevers, diarrhea, rashes, sick contacts, changes in diet, or recent travel. He has decreased urine output and decreased activity. The results of a review of systems are otherwise negative. The child has no significant medical or surgical history, has no known allergies, and takes no medications. The family history is unremarkable. Vital signs are significant for tachycardia (heart rate, 130 beats per minute). Physical examination reveals a tired and non–toxic-appearing boy, who is fussy but easily consoled by his parents. He has slightly dry mucous membranes and an erythematous oropharynx without exudates. The abdomen is mildly distended, soft, diffusely tender, and without guarding or rebound tenderness. There is no organomegaly and no masses can be felt. Bowel sounds are …