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Vomiting of unclear etiology in an autistic child-multiple possible diagnoses: A case report

Matthew Piazza1, Rudolph Baldeo1, Reethamma Daniel1

  • 1Emergency Medicine, Good Samaritan Hospital Medical Center West Islip New York USA.

Journal of the American College of Emergency Physicians Open
|November 4, 2020
PubMed

Insights

Appendicitis is a common emergency department diagnosis, but challenging in non-cooperative children. This case highlights a delayed child with vomiting found to have appendicitis and a choledochal cyst requiring surgery.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Diagnostic Imaging

Background:

  • Appendicitis is a frequent cause of emergency department visits, often diagnosed via history and physical examination.
  • Evaluating vomiting in children, especially those who are developmentally delayed or uncooperative, presents diagnostic challenges.
  • Rarer diagnoses, such as choledochal cysts, can coexist with common surgical conditions.

Observation:

  • A case report details a developmentally delayed child presenting with vomiting.
  • Advanced imaging revealed a large type 1 choledochal cyst, cholecystitis, and appendicitis.
  • The patient required surgical intervention for these coexisting conditions.

Findings:

  • The co-occurrence of appendicitis and a type 1 choledochal cyst is rare.
  • Diagnostic delays can occur in non-cooperative pediatric patients with abdominal symptoms.
  • Advanced imaging is crucial for accurate diagnosis in complex pediatric cases.

Implications:

  • This case underscores the importance of considering multiple diagnoses in pediatric vomiting presentations.
  • Thorough evaluation with advanced imaging is essential when initial assessments are inconclusive.
  • Prompt surgical management is vital for both common and rare coexisting pediatric surgical conditions.

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