Thanks to Lilac Talent @ Miminini for sharing the quality case~
Children's fever clinic, the morning waiting for more children, a mother looked nervous, ran to the door of the clinic, said that her child's stomach pain is severe, suspected that it is an adverse drug reaction, and asked to see first.
I immediately promised the parents that the nurse would give me the child's epidemiological questionnaire first and show it to him first. 8-year-old boy who presents for the third time during his illness.
The first time was because of cough, hoarseness and hoarseness for 1 hour. The receiving physician gave oral treatment of cefixime and prednisone according to "acute laryngitis".
Two days later, the doctor came again, the cough worsened, the hoarseness relieved, accompanied by a runny nose. Oral therapy was given azithromycin, montelukast, and cetirizine.
Three days later, the third visit, the cough decreased significantly, occasionally coughing, with sputum. Abdominal pain appeared the afternoon before the visit, intermittent, not intense, good night sleep, not accompanied by nausea, vomiting, and normal bowel movements the previous afternoon. After eating the remaining porridge from yesterday night in the morning, the abdominal pain worsened after the meal, and the left lower quadrant pain was persistent and unbearable.
The child is carried in by the mother, can not stand, bends over when standing, walks with forced positioning, and when examining the body, the child's left lower limb is bent when lying flat, and he does not want to stretch out.
Physical examination: painful expression, no rash, no abnormalities in cardiac auscultation, thick breath sounds in both lungs, bilateral symmetry, no dry and wet rales heard. The abdomen is slightly distended, the mass is not touched, and there is no tenderness or rebound pain in the upper abdomen, peri-umbilicus, and right lower quadrant. Left lower quadrant abdominal pain refuses to press, local abdominal muscle tension, tenderness, rebound pain is obvious, and bowel sounds are present.
CT of the abdomen suggests peritonitis, intraperitoneal effusion, and confinement of pediatric surgery.
At the end of the afternoon, I saw the child's case, without surgical advice, but gave cefazoxime and ornidazole anti-infection treatment. Curiously, your child's blood routine and CRP results do not indicate a serious bacterial infection!
Contact the pediatric surgeon to ask about the child's condition, and the doctor in charge said that the child's abdominal pain has decreased significantly and he can already eat liquid food.
So, what is the cause of this child's abdominal pain?
Can you diagnose it?