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An 11-year-old girl presented to the emergency department with a week of generalised abdominal pain, anorexia and reduced stooling. The pain did not disturb sleep, and there was no associated weight loss, urinary symptoms or gastrointestinal bleeding. Examination suggested constipation, and an abdominal radiograph (AXR) was performed (figure 1).
1. What does figure 1 show?
Movicol was started, and the patient was discharged. Two further assessments for abdominal pain were sought in the next fortnight. No further investigations were ordered, and there was no change to management.
Three weeks from the original presentation, she developed leg pain and inability to weight-bear. No urinary symptoms were present. Lower limb examination revealed increased tone with extensor plantars bilaterally. A tender posterior right lower thoracic …
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