Two Cases of Abdominal Pain after Trauma.

Abstract

1. Stephanie Hartman, MD* 2. Robin Petroze, MD† 3. Eugene McGahren, MD† 1. *Department of Pediatrics, University of Virginia, Charlottesville, VA. 2. †Department of Surgery, University of Virginia, Charlottesville, VA. A previously healthy 2-year-old girl presents to the emergency department (ED) with a 4-day history of 1 to 2 daily episodes of nonbloody, nonbilious (NBNB) vomiting. She is accompanied by her father, who relates an unwitnessed fall from a playground slide 4 days ago and a sick contact with recent gastroenteritis. That night in the ED, she appears well and has normal vital signs. Clinicians attempt an oral challenge. She has 1 episode of NBNB emesis after eating an ice pop but later tolerates ice chips and water. Because she is 4 days removed from the reported trauma, the ED staff does not believe the emesis is due to any injuries. Her physical examination findings are benign and vital signs are stable, so she is sent home with the diagnosis of likely viral gastroenteritis rather than postconcussive syndrome. Because she has emesis with every meal the next day at home and becomes more tired, her grandmother brings her back to the ED. The girl is somnolent, with dry mucous membranes and decreased urine output. Vital signs include a heart rate of 124 beats per minute, blood pressure of 99/53 mm Hg, and temperature of 36.6°C (97.9°F). Among the results of serum laboratory tests are alanine aminotransferase of 478 U/L (7.98 μkat/L), aspartate aminotransferase of 90 U/L (1.5 μkat/L), hemoglobin of 9.5 g/L (95 g/L), hematocrit of 29.9% (0.3), and anion gap of 25 mEq/L (25 mmol/L). She is given multiple intravenous (IV) …