Meckel's Masquerade: Penetrating the Disguise.

ABSTRACT: Children with abdominal pain are frequently seen in emergency departments. Physicians and parents worry about appendicitis; physicians are also concerned about intussusception and bowel obstruction in patients with previous surgical procedures. Sometimes the patient is ill, and the diagnosis is elusive. In a 6-month period at our pediatric emergency department with an annual census of 57,400 patients, we cared for 4 patients who presented with abdominal pain due to complications of Meckel's diverticulum. None presented with painless rectal bleeding, the complication of which physicians are most aware. We are reporting these patients to raise awareness of Meckel's diverticulum as a cause of acute abdomen in children. Meckel's diverticulum may masquerade as appendicitis, an abdominal mass, intussusception, or a complication of severe constipation.

When a Child Dies Unexpectedly: No Truth Be Told.

Sudden death of a child beyond infancy is a rare event. We report a child who presented to the emergency care system with asystole and the caregiver's report of an asthma attack as the preceding event. After unsuccessful attempts at resuscitation, an autopsy was performed by the medical examiner. Despite only scattered bruises with no clear-cut signs of abuse, aortic rupture and spinal fractures were found. This case highlights the crucial role of the medical examiner in evaluating sudden childhood death, even in the setting of underlying illness.

Stepping outside the box: an adolescent with a new-onset seizure.

First-time seizures are frightening to children and their families, but the practice parameter recommends minimal evaluation in the emergency department (ED) for the child who presents in a neurologically normal state. We report a 12-year-old girl with seizure whose evaluation in the ED included a computed tomographic scan, largely because of parental anxiety. Computed tomography demonstrated a cerebral cavernous hemangioma or cavernoma. Because of the high recurrence risk of seizures with cavernomas, she was discharged from the ED with a prescription for an antiepileptic drug.

All that wheezes: A young infant with a mediastinal mass.

Wheezing infants are frequently encountered in the emergency department. Bronchiolitis is the most commonly seen cause. Radiographs are not recommended in the routine management of bronchiolitis. We present the case of a young wheezing infant with a mildly abnormal chest x-ray whose cystic hygroma caused life-threatening respiratory distress soon after he was admitted to the hospital.