Case 34361

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Abstract
Presentation of CaseA six-year-old schoolboy entered the hospital because of persistent vomiting.Until three weeks before admission the patient had no complaints. He then began to have anorexia and became moderately constipated. Eight days prior to admission he began to vomit on the average of one to three times a day. The vomiting was preceded by episodes of crampy, periumbilical pain. No fever had been present prior to admission.Physical examination revealed a listless, rather poorly nourished boy lying flat in bed, with respirations of 40 to 50 per minute. A diffuse forceful apex impulse was visible extending almost . . .

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