A previously healthy 14-year-old girl presents to the emergency department with 3 days of worsening left-sided abdominal pain. She reports multiple episodes of nonbloody, nonbilious emesis and constipation. She denies sexual activity, dysuria, or fevers and her last menstrual period was 2 weeks ago. She reports occasional constipation, which she treats with over-the-counter laxatives, but is otherwise healthy. Her past surgical history includes a splenectomy after sustaining a traumatic splenic rupture several years earlier. A subphrenic abscess that required surgical drainage complicated her postoperative course, and she had an appendectomy during that procedure.
Physical examination reveals a well-appearing adolescent with a temperature of 36.7°C (98.1°F), heart rate of 113 beats/min, respiratory rate of 16 breaths/min, and blood pressure of 128/96 mm Hg. She has a well-healed midline abdominal scar. Her abdomen is soft and nondistended. She has tenderness to deep palpation but no guarding or rebound tenderness. The rest of...
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