A 9-year-old boy was admitted with a 3-day history of increasingly severe, left-upper-quadrant abdominal pain, anorexia, nausea, vomiting, and constipation. He was previously healthy, but 1 week before admission had fallen from an ice-cream truck and had experienced 2 days of similar, though less severe, symptoms. At a local emergency department, frontal abdominal roentgenograms had been obtained (Figs 1 and 2). He was diagnosed as having constipation and was discharged.
On admission, the child was in obvious discomfort. His temperature was 38.4°C. Pulse and blood pressure were normal. The bowel sounds were diminished. He was splinting to the left, and there was marked left-upper-quadrant tenderness, rebound tenderness, and guarding. The hematocrit level was 0.43, and the white blood cell count, 18.3×109/L. Levels of serum amylase and lactate dehydrogenase were normal. Computed tomography of the abdomen was performed to evaluate possible splenic injury.
Denouement and Discussion
Bochdalek Hernia After
Jacobs BC, Senac MO, Wood BP. Radiological Cases of the Month. Am J Dis Child. 1993;147(1):69–70. doi:10.1001/archpedi.1993.02160250071021
Pediatrics in JAMA: Read the Latest
Customize your JAMA Network experience by selecting one or more topics from the list below.