Management of Abdominal Pain and Emesis in a 12-Month Old

In Episode 45 of Med School Question of the Week for USMLE, Alisa Khomutova, MedSchoolCoach expert tutor, answers this medical school question: A previously healthy 1-year old boy is brought to the emergency department for the evaluation of abdominal pain and vomiting. His parents state that over the past 10 hours he has been having intermittent episodes of inconsolable crying, during which he draws up his legs and writhes. These episodes have been accompanied by nonbloody, nonbilious vomiting and reddish, mucoid bowel movements. On physical exam, temperature is 37.9°C blood pressure 100/60 mm Hg, pulse is 120/min, and respirations are 23/min. He cries when his abdomen is palpated. The remainder of the examination shows no abnormalities. Labs are wnl. An abdominal x-ray shows no free air and moderate gas in the small bowel. An abdominal ultrasonography is pending. Which of the following is the most likely next step in management?

• Pyloromyotomy
• Air enema
• Technetium 99m pertechnetate scan
• Ladd procedure
• CT scan
• Laparotomy