A Girl had a 2-year history of abdominal pain

This 8-year-old girl had a 2-year history of abdominal pain.

Question

An 8 1/2-year-old girl was admitted to the hospital because of an abdominal mass and pain.

The child had had recurrent abdominal pain during the preceding two years. Her mother believed that the symptoms had begun at about the time that an elevated coliform count was discovered in the local water supply. Seventeen months before admission, the girl’s blood count and sedimentation rate were normal, and stool examination showed no ova or parasites. Seven weeks before admission, intermittent fevers began, with anorexia, loss of about 4.5 kg in weight, and a reduction in the frequency of bowel movements. Six weeks before admission, a radiograph of the abdomen showed a nonspecific pattern of bowel gas and stool throughout the colon; there was a calcified nodule in the right upper quadrant that was consistent with the presence of a gallstone. Treatment with mineral oil was recommended, but it provoked vomiting and was discontinued. Five days before admission, the child began to vomit all ingested foods and liquids. She had fever and diarrhea, with dark stools but no obvious hematochezia. Two days later, her temperature rose to 39.9°C

What is the diagnosis?

Crohn’s disease
Enteric duplication cyst
Pancreatic pseudocyst
Intestinal malrotation
Wilms’ tumor

 

Created by USMLE PlAB MCQ

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