Case 1: abdominal pain and coffee ground emesis in a 9-year-old boy. Case 2: vomiting, headache, and seizures in a 7-year-old boy. Case 3: primary amenorrhea in a 15-year-old girl.

摘要

A 9-year-old boy presents to the ED with severe abdominal pain and vomiting. He has no history of diarrhea, fever, chills, rash, trauma, arthralgia, or headache. He has no prior history of gastrointestinal complaints or other chronic illnesses. He cannot tolerate clear liquids and is admitted for observation. He vomits coffee ground material and then blood.On physical examination, his temperature is 38.5degC, heart rate is 140 beats/min, blood pressure is 123/83 mm Hg, and respiratory rate is 24 breaths/min. He is uncomfortable and diaphoretic. He has tachycardia, but his cardiopulmonary examination results are normal otherwise. He has generalized abdominal tenderness, with guarding and rebound tenderness most pronounced in the periumbilical region and extending to the right lower quadrant. Hip abduction elicits pain.