Case 1: Abdominal Distention In A 2-Month-Old Boy

1. Diana Haddad, MD* 2. Sandeep Gangadharan, MD† 1. *Department of Pediatric Critical Care Medicine, Cohen Children’s Medical Center, New Hyde Park, NY 2. †Department of Pediatric Critical Care Medicine, Children’s Hospital at Montefiore, Bronx, NY Has 2019 been perfect? Even amidst good times, we often face challenges. Some of the challenges are because we battle structures and systems that just weren’t made perfectly, and sometimes we face challenges of imperfect processes. This month, the Index of Suspicion cases (and some of the other articles in this issue) deal with structural and biochemical (process) problems. Enjoy! Philip R. Fischer, MD Associate Editor, Index of Suspicion A 2-month-old full-term boy with normal prenatal ultrasonography findings and an unremarkable birth history presents to the emergency department with several days of forceful, nonbloody, nonbilious vomiting and worsening abdominal distention. His oral intake and urine output are decreased. His history is significant for gastroesophageal reflux, but he is developing well. On examination he appears ill. His vital signs are significant for hypertension (blood pressure, 160/90 mm Hg) and tachypnea with shallow breathing. He has a distended abdomen and mottled extremities. The physical examination findings are otherwise normal. He has not had fevers, rash, swelling, or changes in his stools. An abdominal radiograph reveals no evidence of obstruction or intraperitoneal free …