Adolescent with abdominal pain poorly responsive to analgesia
Hart, James W.
JournalArchives of disease in childhood. Education & practice edition.
Rights© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.
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Case presentation A 14-year-old boy, with autism spectrum disorder, presented with a 1-day history of colicky abdominal pain, non-bilious vomiting, anorexia and loose normal-coloured stool. Two days previously, he had a poorly reheated takeaway chicken. On examination, body mass index (BMI) was >99th centile. He had inconsistent epigastric, periumbilical and umbilical tenderness, and guarding, with normal bowel sounds. Observations were within normal limits, but his pain was poorly responsive to paracetamol, ibuprofen, hyoscine butylbromide, codeine and morphine. Investigations are in table 1. On day 3, his temperature increased to 38.5° and a CT scan was performed, which showed concerning features (figure 1).edpract;archdischild-2020-320772v1/T1T1T1Table 1Serology and further investigations throughout admission Day 1Day 2Day 3Day 4Serology White cell count (3.8-10.6×109/L)7.514.615.713.6 Neutrophils (1.8-8.0×109/L)5.312.312.85.3 C reactive protein (<5 mg/L)12010398 Bilirubin (0-21 μmol/L)812Further investigations Urine dipstick Negative Ultrasound Small volume of free fluid, normal gallbladder, pancreas and appendix not visualisededpract;archdischild-2020-320772v1/F1F1F1Figure 1CT scan of the abdomen (A) and pelvis (B). QUESTIONS: What is the diagnosis?Appendicitis.Pancreatitis.Cholecystitis.Gastroenteritis.Which serology would have been most helpful at presentation? Renal function. Coagulation. Amylase and lipase. Gamma glutamyltransferase. What are the acute treatment principles? What is the the most common cause? Idiopathic. Gallstones. Medications. Genetic. Answers can be found on page 2.