Intrinsic

A 12 year old boy presents with non projectile bilious vomiting, abdominal distension and colicky epigastric pain for 2 days. There is no history of constipation, fever or jaundice.

He gives a longstanding history of similar but much milder episodes after large meals, none of which required hospital admission. He also suffers from intermittent dyspeptic symptoms.

His medical history is otherwise unremarkable and his full blood count is normal.

Select Relevant Investigations
X-Ray Abdomen

Performed

The erect x-ray of the abdomen shows generalized haziness with no bowel shadows visible. A distended gastric air bubble is noted, without a visible fluid level. There is no evidence of pneumoperitoneum.
Urea & Electrolytes

Performed

Na+ : 133 mEq/l (normal)
K+ : 4.0 mEq/l (normal)
Cl- : 98 mEq/l (normal)

Urea: 38 mg/dl (normal)
Serum Creatinine: 0.44 mg/dl (normal)
Serum Lipase

Performed

The Serum Lipase is 45 U/l (normal)
Contrast CT Abdomen

Performed

There is dilation of the stomach and proximal duodenum, with an abrupt decrease in the width of the third part of the duodenum beyond the crossing of the superior mesenteric artery (SMA). The aortomesenteric angle is reduced.

Select Relevant Management
IV Fluids stat
IV Antibiotics stat
NG tube stat
IV Morphine