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Look up! An unexpected cause of abdominal pain in an infant
  1. Ian Kendall1,
  2. Martha McKenna1,
  3. Richard L Conn1,2,
  4. Alistair C Dick3
  1. 1 Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, UK
  2. 2 Centre for Medical Education, Queen's University Belfast, Belfast, UK
  3. 3 Paediatric Surgery, Royal Belfast Hospital for Sick Children, Belfast, UK
  1. Correspondence to Dr Martha McKenna, Paediatrics, Royal Belfast Hospital for Sick Children, Belfast, BT12 6BA, UK; mmckenna53{at}

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A previously well 9-month-old girl attended the emergency department following episodes of profound pallor, inconsolable crying and drawing her legs up. She had no vomiting, change in stooling or fever. She was born at term with no neonatal complications. On examination, her vital signs were stable, and her abdomen was soft. Blood tests including inflammatory markers were unremarkable.

Test your knowledge

  1. Which diagnosis is most likely?

    1. Appendicitis

    2. Intussusception

    3. Mesenteric adenitis

    4. Strangulated inguinal hernia

    5. Viral gastroenteritis

  1. Which investigation would you like to perform?

    1. Abdominal X-ray

    2. Abdominal ultrasound

    3. CT of the abdomen

    4. Chest X-ray

    5. Barium meal

Following normal investigations, the baby was discharged with safety netting advice. She returned 1 week later with ongoing symptoms. A chest X-ray was performed (figure 1).

Figure 1

Supine posteroanterior chest radiograph.

  1. What finding is …

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  • Twitter @richardlconn

  • Contributors IK and MM wrote the submission, which was reviewed, edited and agreed upon by RLC and ACD.

  • 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.