A 12-year-old girl has had abdominal pain for 3 hours. The pain developed suddenly and is severe, sharp, constant, and located in the epigastrium and lower quadrants, with no radiation. She has had five episodes of bilious, nonbloody emesis. The pain worsens with movement and vomiting, and she has found no way to relieve it. Her last bowel movement was yesterday and was normal. She has had no fever, diarrhea, bloody stools, or back pain. Past medical history reveals intermittent constipation.

On physical examination, her temperature is 96.3°F (35.7°C), heart rate is 106 beats/min, respiratory rate is 14 breaths/min, and blood pressure is 103/60 mm Hg. Her abdomen is soft and slightly distended, with hypoactive bowel sounds and both right and left lower quadrant tenderness. Slight voluntary guarding is noted. The rest of the physical findings are normal.

Her WBC is 9.6×103/mcL (9.6×109/L), Hgb is 11.4...

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