The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.
The parents of a 7-month-old boy bring him to the emergency department (ED) owing to recent lethargy and an 18-hour history of pain that his parents believe stems from his abdomen. He is a previously healthy and well-nourished boy without any significant medical history. He was born at term via vaginal delivery, and his neuromotor development is adequate for his age. His vaccinations are up to date.
Four weeks ago, he developed a common cold, with runny nose, low-grade fever, and sneezing, which subsided in 3 days with symptomatic treatment (acetaminophen, hydration, and physical measures). The afternoon before arrival to the ED, he appeared to be in significant pain, accompanied by inconsolable crying and drawing up his legs toward the abdomen. Between painful episodes, the child behaved relatively normally and free of pain; he was even able to fall asleep before waking again with pain. Since then, he has vomited gastric contents four times. Two hours before admission, he became lethargic, just waking up to cry during the colic episodes.
Medscape © 2015
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Jaime Shalkow. 7-Month-Old Boy With Abdominal Pain and Rectal Bleeding - Medscape - Dec 17, 2015.