Pediatric Annals

Firm Rounds 

A 3-Year-Old Girl with Intermittent Fever and Abdominal Pain

Robert Listernick, MD

Abstract

This previously healthy 3-year-old girl was admitted following a 3-month history of intermittent fever and abdominal pain. She initially had a 2-week history of intermittent vomiting and fever without diarrhea. Although this resolved, she continued to have 2 weeks of intermittent periumbilical abdominal pain and fever on a daily basis. After 2 weeks, she developed 3 weeks of watery, non-bloody diarrhea with continued intermittent fever. She had been treated with multiple doses of acetaminophen during her illness. She was seen during this time period in several emergency rooms. Over the course of the illness, she had lost 5 pounds. Birth history was unremarkable. The family history was only remarkable because her mother had had a recent illness, which had consisted of vomiting, fever, and diarrhea. Her past medical history was significant for recurrent episodes of otitis media with bilateral myringotomy tube placement at 1 year of age. At home, there is one dog, one old cat, and four kittens. Her mother is a food handler. Evaluation at an outside hospital included normal electrolytes, ALT 116 IU/mL, albumin 3.1 mg/dL, and negative stool culture, rotavirus antigen test, and stool examination for parasites.

Key Learning Points

  1. Ten percent to 15% of healthy school-age children have functional chronic abdominal pain.
  2. Ultrasonography is the best initial test for imaging the biliary tract.
  3. Choledochal cysts can be several centimeters in diameter and are sometimes palpable. There’s generally no liver dysfunction until the biliary tract obstruction becomes complete.
  4. Asymptomatic small-bowel intussusceptions are seen regularly on computerized tomography scans. They are evanescent, and don’t cause obstruction. No treatment is necessary unless they persist and lead to a small bowel obstruction.
  5. The likelihood of lead poisoning is higher in children who ingest coins or other foreign objects.

ABOUT THE AUTHOR

Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL

Abstract

This previously healthy 3-year-old girl was admitted following a 3-month history of intermittent fever and abdominal pain. She initially had a 2-week history of intermittent vomiting and fever without diarrhea. Although this resolved, she continued to have 2 weeks of intermittent periumbilical abdominal pain and fever on a daily basis. After 2 weeks, she developed 3 weeks of watery, non-bloody diarrhea with continued intermittent fever. She had been treated with multiple doses of acetaminophen during her illness. She was seen during this time period in several emergency rooms. Over the course of the illness, she had lost 5 pounds. Birth history was unremarkable. The family history was only remarkable because her mother had had a recent illness, which had consisted of vomiting, fever, and diarrhea. Her past medical history was significant for recurrent episodes of otitis media with bilateral myringotomy tube placement at 1 year of age. At home, there is one dog, one old cat, and four kittens. Her mother is a food handler. Evaluation at an outside hospital included normal electrolytes, ALT 116 IU/mL, albumin 3.1 mg/dL, and negative stool culture, rotavirus antigen test, and stool examination for parasites.

Key Learning Points

  1. Ten percent to 15% of healthy school-age children have functional chronic abdominal pain.
  2. Ultrasonography is the best initial test for imaging the biliary tract.
  3. Choledochal cysts can be several centimeters in diameter and are sometimes palpable. There’s generally no liver dysfunction until the biliary tract obstruction becomes complete.
  4. Asymptomatic small-bowel intussusceptions are seen regularly on computerized tomography scans. They are evanescent, and don’t cause obstruction. No treatment is necessary unless they persist and lead to a small bowel obstruction.
  5. The likelihood of lead poisoning is higher in children who ingest coins or other foreign objects.

ABOUT THE AUTHOR

Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL

This previously healthy 3-year-old girl was admitted following a 3-month history of intermittent fever and abdominal pain. She initially had a 2-week history of intermittent vomiting and fever without diarrhea. Although this resolved, she continued to have 2 weeks of intermittent periumbilical abdominal pain and fever on a daily basis. After 2 weeks, she developed 3 weeks of watery, non-bloody diarrhea with continued intermittent fever. She had been treated with multiple doses of acetaminophen during her illness. She was seen during this time period in several emergency rooms. Over the course of the illness, she had lost 5 pounds. Birth history was unremarkable. The family history was only remarkable because her mother had had a recent illness, which had consisted of vomiting, fever, and diarrhea. Her past medical history was significant for recurrent episodes of otitis media with bilateral myringotomy tube placement at 1 year of age. At home, there is one dog, one old cat, and four kittens. Her mother is a food handler. Evaluation at an outside hospital included normal electrolytes, ALT 116 IU/mL, albumin 3.1 mg/dL, and negative stool culture, rotavirus antigen test, and stool examination for parasites.

Key Learning Points

  1. Ten percent to 15% of healthy school-age children have functional chronic abdominal pain.
  2. Ultrasonography is the best initial test for imaging the biliary tract.
  3. Choledochal cysts can be several centimeters in diameter and are sometimes palpable. There’s generally no liver dysfunction until the biliary tract obstruction becomes complete.
  4. Asymptomatic small-bowel intussusceptions are seen regularly on computerized tomography scans. They are evanescent, and don’t cause obstruction. No treatment is necessary unless they persist and lead to a small bowel obstruction.
  5. The likelihood of lead poisoning is higher in children who ingest coins or other foreign objects.

ABOUT THE AUTHOR

Dr. Listernick is Professor of Pediatrics at Feinberg School of Medicine, Northwestern University, and Director of the Diagnostic and Consultation Service, Division of General Academic Pediatrics, Children’s Memorial Hospital, Chicago, IL

10.3928/00904481-20080601-05

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