A 9-year-old boy was admitted with a 3-day history of increasingly severe, left-upper-quadrant abdominal pain, anorexia, nausea, vomiting, and constipation. He was previously healthy, but 1 week before admission had fallen from an ice-cream truck and had experienced 2 days of similar, though less severe, symptoms. At a local emergency department, frontal abdominal roentgenograms had been obtained (Figs 1 and 2). He was diagnosed as having constipation and was discharged.
On admission, the child was in obvious discomfort. His temperature was 38.4°C. Pulse and blood pressure were normal. The bowel sounds were diminished. He was splinting to the left, and there was marked left-upper-quadrant tenderness, rebound tenderness, and guarding. The hematocrit level was 0.43, and the white blood cell count, 18.3×109/L. Levels of serum amylase and lactate dehydrogenase were normal. Computed tomography of the abdomen was performed to evaluate possible splenic injury.
Denouement and Discussion
Bochdalek Hernia After