Section of Emergency Medicine, University of Wisconsin Hospital and Clinics, F2/210 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3284, USA.
CJEM. 2011 Mar;13(2):133-8. doi: 10.2310/8000.2011.110163.
Chronic and recurrent abdominal pains are common complaints in children and adolescents, but the evaluation in the emergency department (ED) can be challenging. We present a rare yet serious case of a 17-year-old white female who presented to the ED with a 2-day history of diffuse abdominal pain, nausea, and intractable vomiting. Abdominal examination and imaging, including computed tomography (CT), were negative during an episode 6 weeks previously. This was her fifth similar episode in a 2-month period, and she had been seen at three different hospitals and admitted on each occasion. Three days prior to presentation to our ED, she was seen at a gastroenterology clinic and diagnosed with irritable bowel syndrome and an ovarian cyst. Symptomatic therapy during the current presentation, with intravenous fluids, antiemetics, and parenteral narcotics, failed to alleviate her abdominal pain and vomiting. Emergent CT evaluation revealed a high-grade colonic obstruction with focal circumferential narrowing in the transverse colon and a lower gastrointestinal follow-through radiograph with Gastrografin enema showed a classic "apple-core" lesion. Colonic adenocarcinoma with positive regional lymph nodes was found during emergent exploratory laparotomy. Pediatric patients with recurrent, episodic abdominal pain should undergo systematic evaluation and symptomatic treatment. A previous negative workup should not dissuade emergency physicians from proceeding with a systematic and thorough evaluation of the pediatric patient presenting with abdominal pain and vomiting.
慢性和复发性腹痛是儿童和青少年常见的主诉，但在急诊科（ED）的评估可能具有挑战性。我们介绍了一个罕见但严重的病例，一名 17 岁白人女性因弥漫性腹痛、恶心和顽固性呕吐就诊于 ED，病史为 2 天。6 周前的一次发作中，腹部检查和影像学检查，包括计算机断层扫描（CT），均为阴性。这是她在 2 个月内的第五次类似发作，她曾在三家不同的医院就诊并每次住院。在就诊于我们的 ED 前 3 天，她在胃肠病诊所就诊，被诊断为肠易激综合征和卵巢囊肿。在当前发作期间，给予静脉补液、止吐药和肠外麻醉药进行对症治疗，但未能缓解她的腹痛和呕吐。紧急 CT 评估显示升结肠高级别梗阻，横结肠局灶性环形狭窄，下消化道透视加泛影葡胺灌肠显示典型的“苹果核”病变。在紧急剖腹探查中发现结肠腺癌伴局部淋巴结阳性。反复出现阵发性腹痛的儿科患者应进行系统评估和对症治疗。以前的阴性检查结果不应阻止急诊医生对出现腹痛和呕吐的儿科患者进行系统和彻底的评估。
