7-Month-Old Boy With Abdominal Pain and Rectal Bleeding

Jaime Shalkow, MD


December 17, 2015

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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.


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