A 13-month-old white boy presents to the emergency department (ED) with sudden onset of abdominal discomfort and lethargy. There is no history of fevers, vomiting, or diarrhea. He was born at 39 weeks' gestation by spontaneous vaginal delivery. He has had no surgery, and he does not take any medications. His immunizations are up to date and he is devel-opmentally appropriate. Some older family members have had gastric, uterine, and cervical cancers. Physical examination reveals a crying but consolable child. He is afebrile with a heart rate of 123 beats per minute, blood pressure of 107/60 mm Hg, respiratory rate of 37 breaths per minute, and oxygen saturation of 97% on room air. His abdomen is soft and nontender, with mild guarding; there are no masses or hepatosplenome-galy. Neurologic examination reveals normal strength and deep tendon reflexes. A rectal examination is deferred because of parental request.
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