A Traumatic Quinceañera

A 15 year old, previously healthy female presented to the pediatric emergency department with 3 days of hematemesis, worsening abdominal distention, and diffuse abdominal pain. Her emesis began as non-bloody, non-bilious, however over the past 2 days has progressed to become biluous and grossly bloody. She has had no bowel movement and no known flatus for 2 days. On the day of presentation, she was seen by her pediatrician who ordered an abdominal CT and subsequently referred her to the emergency department. Of note, 1 week prior to her presentation the patient celebrated her Quinceañera where she reports wearing a very tight corset and restricting her oral intake prior to the party to fit into her dress. Her discomfort may have persisted after her …show more content…
A subsequent upper gastrointestinal fluoroscopy demonstrated a dilation of the duodenum through the level of its mid third portion with distal decompression. No evidence of malrotation or gastric volvulus was seen. A review of the CT done prior to her presentation revealed a massively dilated stomach and proximal duodenum to the region of the superior mesenteric artery (SMA) and distally decompressed.
The patient was given a total of 80cc/kg of normal saline with improvement in her perfusion and tachycardia. A nasogastric (NG) tube was placed which resulted in 2 liters of grossly bloody gastric contents. The general surgery attending was able to largely decompress the stomach through manipulation of the NG tube and manual pressure on the stomach, after which the patient reported significant symptomatic improvement. The patient was given antibiotics, a proton pump inhibitor and subsequently admitted to the Pediatric Intensive Care Unit for hypovolemic shock and gastrointestinal