A 10-Year-Old Boy Is Brought to the Emergency Department Due

question 540

Multiple Choice

A 10-year-old boy is brought to the emergency department due to postprandial abdominal pain and bilious emesis.  He has never had similar symptoms and has no other medical conditions.  Two days ago, the patient stopped his bicycle abruptly and slammed into the handlebar.  He immediately experienced abdominal pain, which improved over the next several hours.  Vital signs are normal.  Physical examination shows epigastric tenderness without rigidity or rebound tenderness.  Bowel sounds are normal.  Bedside ultrasonography reveals no intraperitoneal free fluid.  Plain abdominal radiograph shows gastric dilation with scant distal gas.  Laboratory results are as follows: Which of the following is the most likely diagnosis?

• A)Duodenal hematoma
• B)Liver laceration
• C)Pancreatic pseudocyst
• D)Pyloric stenosis
• E)Small-bowel perforation