Ruptured

An 11-year-old boy presents with acute central abdominal pain for five hours. A short while before the onset of symptoms, he had sustained minimal blunt trauma to the same area when playing with his friends.

He also complains of pruritus all over his body, particularly the limbs and trunk, which started soon after the injury. His medical, surgical, and family histories are unremarkable. His family migrated from Kenya around 2 years ago.

Select Relevant Investigations
Complete blood count

Performed

WBC/DC: 17,600/mm3 (4,600-11,000)
N: 75% L: 11% E: 10%
Hb: 13.5 g/dL (12-18)
Hct: 41.5% (35-45)
Platelets: 370,000/mm3 (150,000-400,000)
Ultrasound of the abdomen

Performed

There are two multiseptated cystic lesions measuring 6.2 x 4.1 cm and 7.8 x 6.8 cm respectively, within the right lobe of the liver. These cysts demonstrate hypoechoic contents, floating echogenic membranes, and peripheral calcifications. Free fluid is noted in all quadrants of the abdomen.
CT scan abdomen

Performed

You realize that a CT scan is not indicated right now.
Chest X-ray

Performed

No abnormalities seen

Select Relevant Management
Epinephrine
Establish IV access
Blood transfusion
Exploratory laparotomy