CLINICAL HISTORY.—A 9-year-old Negro boy received a puppy for Christmas. While running with the puppy on Dec 26, he fell across an outdoor water hydrant, striking his right upper quadrant near the midline. The boy cried a bit but did not seem seriously injured. Shortly thereafter, however, he became nauseated. He experienced several episodes of vomiting prior to his admission to the University of Florida Teaching Hospital some five hours after the trauma.
On admission the patient was hiccupping but seemed to be in no acute distress. There was slight right upper quadrant tenderness with minimal guarding. No abdominal masses were palpable and there was no rebound tenderness. The vital signs were normal.
Pertinent laboratory findings included hematocrit, 36; white blood cell count, 11,400; urinalysis, normal; stool, negative for blood; and bilirubin 1.3.
Radiographic examination of the abdomen demonstrated loss of definition of the superior margin of the right psoas