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An unusual case of pediatric abdominal pain

Published online by Cambridge University Press:  11 May 2015

Lars P. Bjoernsen  and
M. Bruce Lindsay
Lars P. Bjoernsen
Affiliation:
Section of Emergency Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
M. Bruce Lindsay*
Affiliation:
Section of Emergency Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
*
Section of Emergency Medicine, University of Wisconsin Hospital and Clinics, F2/210 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3284; [email protected]

Abstract

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Chronic and recurrent abdominal pains are common complaints in children and adolescents, but the evaluation in the emergency department (ED) can be challenging. We present a rare yet serious case of a 17-year-old white female who presented to the ED with a 2-day history of diffuse abdominal pain, nausea, and intractable vomiting. Abdominal examination and imaging, including computed tomography (CT), were negative during an episode 6 weeks previously. This was her fifth similar episode in a 2-month period, and she had been seen at three different hospitals and admitted on each occasion. Three days prior to presentation to our ED, she was seen at a gastroenterology clinic and diagnosed with irritable bowel syndrome and an ovarian cyst. Symptomatic therapy during the current presentation, with intravenous fluids, antiemetics, and parenteral narcotics, failed to alleviate her abdominal pain and vomiting. Emergent CT evaluation revealed a high-grade colonic obstruction with focal circumferential narrowing in the transverse colon and a lower gastrointestinal follow-through radiograph with Gastrografin enema showed a classic “apple-core” lesion. Colonic adenocarcinoma with positive regional lymph nodes was found during emergent exploratory laparotomy. Pediatric patients with recurrent, episodic abdominal pain should undergo systematic evaluation and symptomatic treatment. A previous negative workup should not dissuade emergency physicians from proceeding with a systematic and thorough evaluation of the pediatric patient presenting with abdominal pain and vomiting.

Keywords

abdominal painadenocarcinomaadolescencecolorectalpathology
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 2 , March 2011 , pp. 133 - 138
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

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