An 18 month old male was presented to the emergency department after six hours of stomach pain. He awoke at 4 am crying. His mother carried him and he settled down after a few minutes and then fell back asleep. Over the next few hours, he woke up intermittently crying. His appetite has been poor since the onset of these symptoms. He is able to walk but prefers to be carried by his mom this morning. He is less playful than usual. He would sometimes bend down crying. There is no vomiting or diarrhea.
His last stool yesterday was normal. There is no fever, cough, or runny nose. There is no history of abdominal trauma. Exam: VS T37.6, P 118, R 24, BP 85/55, weight 11kg. He is awake, alert, and being carried by mom. His skin is pink with good perfusion and brisk capillary refill. His oral mucosa is pink and moist. There are no ulcers in the posterior pharynx. His abdomen…
