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Not so fun at the funfair…
  1. Diarmuid McLaughlin,
  2. Martin Hanna,
  3. Patrice Eastwood,
  4. Peter Mallett,
  5. Andrew Thompson
  1. Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Diarmuid McLaughlin, Paediatric Rheumatology, Royal Belfast Hospital for Sick Children, Belfast, BT12 6BA, UK; dmclaughlin{at}

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A 1-year-old girl presented with a 3-day history of non-bilious vomiting, reduced intake and lethargy. Her last bowel movement was 4 days prior. She was previously well with no ill contacts or foreign travel. On examination, she was tachycardic with a prolonged capillary refill time. Her abdomen was soft, not distended with no palpable masses. Blood tests including full blood count, renal and C reactive protein (CRP) were normal. She initially received supportive treatment with intravenous fluids and analgesia. On day 4 of admission, an abdominal X-ray (AXR) was performed due to persistent vomiting (figure 1).

Figure 1

Abdominal X-ray demonstrating dilated small bowel loop in left lower quadrant.

Test your knowledge

  1. What is the most likely diagnosis?

    1. Acute infective gastritis

    2. Intestinal malrotation

    3. Severe constipation

    4. Small bowel obstruction

She became progressively more unwell. A further detailed history revealed the family had recently returned from a family trip to the funfair. Pale green, bilious vomiting was observed and examination revealed abdominal distension with no overt signs of …

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  • Twitter @diarmclaughlin, @SimEdRBHSC, @No twitter

  • Contributors DM, MH and PE were involved in patient care. All authors were involved in manuscript design and serial drafts and approved the final copy.

  • 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 None declared.

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