An 11 month old male with history of "stomach flu" symptoms two weeks ago that had resolved, now presents to the ED with emesis five times the night prior, without blood or bilious material. In the morning he had three loose stools with blood but no mucous. There are no URI symptoms, and no history of fever.

He cries intermittently in cycles of 10 to 20 minutes. His past medical history is unremarkable.Exam: Vital signs T36.5Ax, P118, RR40, Wt 50%ile. He is alert, smiling, and not toxic appearing. Skin exam shows good perfusion (capillary refill time 2 seconds). Pupils reactive. Tympanic membranes no erythema. Oral mucosa moist. Heart regular, no murmur. Lungs clear breath sounds, good aeration. Abdomen soft, flat, active bowel sounds, no mass palpated. Testes descended bilaterally, nontender. No anal fissure, stool heme-positive. Pulses were good.A stool culture was sent and an abdominal series was obtained.

View abdominal series: Supine (Flat) view



View abdominal series: Upright view

There is a suspicion of a soft-tissue mass in the right upper quadrant. There is some distention of a single loop of small bowel in the mid-abdomen and gaseous distention of the transverse colon and proximal left colon. No peritoneal free air. The liver edge is not easily identified in these views (the absent liver edge sign). There is a paucity of bowel gas.

What is the diagnosis?

Last Created on 01-07-2006