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Adolescent with abdominal pain poorly responsive to analgesia
  1. Neil Chanchlani1,
  2. Philip Jarvis2,
  3. James W Hart1,
  4. Christine H McMillan1,
  5. Christopher R Moudiotis1
  1. 1 Paediatrics, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  2. 2 Radiology, Torbay and South Devon NHS Foundation Trust, Torquay, Torbay, UK
  1. Correspondence to Dr Neil Chanchlani, Royal Devon and Exeter NHS Foundation Trust, Exeter, EX2 5DW, UK; nchanchlani{at}


Case presentation A 14-year-old boy, with autism spectrum disorder, presented with a 1-day history of colicky abdominal pain, non-bilious vomiting, anorexia and loose normal-coloured stool. Two days previously, he had a poorly reheated takeaway chicken.

On examination, body mass index (BMI) was >99th centile. He had inconsistent epigastric, periumbilical and umbilical tenderness, and guarding, with normal bowel sounds. Observations were within normal limits, but his pain was poorly responsive to paracetamol, ibuprofen, hyoscine butylbromide, codeine and morphine.

Investigations are in table 1. On day 3, his temperature increased to 38.5° and a CT scan was performed, which showed concerning features (figure 1).

Table 1

Serology and further investigations throughout admission

Figure 1

CT scan of the abdomen (A) and pelvis (B).


  1. What is the diagnosis?

    1. Appendicitis.

    2. Pancreatitis.

    3. Cholecystitis.

    4. Gastroenteritis.

  2. Which serology would have been most helpful at presentation?

    1. Renal function.

    2. Coagulation.

    3. Amylase and lipase.

    4. Gamma glutamyltransferase.

  3. What are the acute treatment principles?

  4. What is the the most common cause?

    1. Idiopathic.

    2. Gallstones.

    3. Medications.

    4. Genetic.

Questions Answers can be found on page 2.

  • adolescent health
  • gastroenterology
  • genetics

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  • Contributors NC wrote the article; PJ reviewed the images and provided the captions; and JH, CMc and CMo reviewed and provided comments on all versions of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NC is funded as a clinical research fellow by Crohn’s and Colitis UK.

  • Provenance and peer review Not commissioned; internally peer reviewed.