Case presentation: A previously healthy 10-year-old girl was presented to the clinic following 3 days of nausea and vomiting with mild diffuse abdominal pain. She had nausea over a 3-day period with frequent episodes of non-bloody, non-bilious emesis. The first day of illness she was vomiting every 20 minutes. On the following 2 days she vomited only after eating and drinking. Due to her persistent emesis, her oral intake had significantly decreased by time of presentation and she had developed significant fatigue.
Examination: On physical examination, she was afebrile with tachycardia to 120 and mild hypertension of 131/84. During her abdominal exam, she demonstrated periumbilical and right sided tenderness to palpation. She had normoactive bowel sounds without guarding or rebound tenderness. Psoas and obturator signs were negative. No masses were palpated, and she did not have…
