Why Cry?

Step 1: View clinicals

A 1 year old boy presents with intermittent crying for 1 day. There is no history of fever, vomiting, diarrhea, or urinary frequency. He was completely healthy previously, with normal growth and development. All immunizations are up to date.

Step 2: Order all relevant investigations

Complete Blood Count

WBC: 8,000/mm3 (5,500-15,500) Hb: 13 g/dL (10.5-13.5) Hct (PCV): 35% (33-49) Platelets: 288,000/mm3 (150,000-450,000) Blood film: Normal

Ultrasound Abdomen

There is a target lesion in the right upper abdomen on transverse imaging. The lesion shows the pseudokidney sign on longitudinal imaging. No other abnormalities are detected.

Contrast CT Abdomen

The oral and intravenous contrast CT study confirms the presence of a target lesion in the right upper abdomen. No other abnormalities are detected.

Upper GI Endoscopy

You attempt to rationalize why upper GI endoscopy is indicated, and fail.

Step 3: Select appropriate management

IV Fluids
NG Tube
Air Enema
Urgent Surgery

Score: ★★☆