family medicine
42-year-old woman presents with abdominal pain for the last 2 days
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A 10-year-old afebrile boy presents with a history of abdominal pain for 2 days. The pain is spasmodic, intermittent, usually periumbilical, and occasionally severe, but he has not been vomiting. His last bowel movement was yesterday and was reportedly hard and difficult to pass. His mother states that he has had similar episodes of pain on and off over the last 6 months, and these have often been accompanied by difficulty passing stool.
On physical examination, the patient appears well. The lower abdomen is distended, with a firm and mildly tender mass palpated in the left lower quadrant. There is no rigidity or guarding, and firm stool, but no lesion or mass, is palpable on rectal examination.
Upright abdominal x-ray reveals distension of the sigmoid and descending colon with stool; the rest of the bowel appears unremarkable.
What is the most appropriate management?
- computed tomography to rule out malignancy
- plain x-ray of the abdomen
- immediate surgical consultation
- administration of enema
This question appears in Med-Challenger Pediatric Medicine Exam Review with CME
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