Case 1: abdominal pain and coffee ground emesis in a 9-year-old boy. Case 2: vomiting, headache, and seizures in a 7-year-old boy. Case 3: primary amenorrhea in a 15-year-old girl.

* ALT: : alanine aminotransferase AST: : aspartate aminotransferase BUN: : blood urea nitrogen CBC: : complete blood count CNS: : central nervous system CSF: : cerebrospinal fluid CT: : computed tomography ECG: : electrocardiography ED: : emergency department EEG: : electroencephalography ESR: : erythrocyte sedimentation rate GI: : gastrointestinal GU: : genitourinary Hct: : hematocrit Hgb: : hemoglobin MRI: : magnetic resonance imaging WBC: : white blood cell A 9-year-old boy presents to the ED with severe abdominal pain and vomiting. He has no history of diarrhea, fever, chills, rash, trauma, arthralgia, or headache. He has no prior history of gastrointestinal complaints or other chronic illnesses. He cannot tolerate clear liquids and is admitted for observation. He vomits coffee ground material and then blood. On physical examination, his temperature is 38.5°C, heart rate is 140 beats/min, blood pressure is 123/83 mm Hg, and respiratory rate is 24 breaths/min. He is uncomfortable and diaphoretic. He has tachycardia, but his cardiopulmonary examination results are normal otherwise. He has generalized abdominal tenderness, with guarding and rebound tenderness most pronounced in the periumbilical region and extending to the right lower quadrant. Hip abduction elicits pain. CBC documents a normal Hgb value and platelet and leukocyte counts, with a left shift and 78% neutrophils. Urinalysis shows moderate blood and trace proteinuria, with 2 RBCs per high-power field. The chest radiograph appears normal. The abdominal radiograph shows a few mildly distended small bowel loops but no radiographic evidence of obstruction. CT scan of the abdomen leads to exploratory laparoscopy and the correct diagnosis. A 7-year-old developmentally appropriate boy presents to the ED with a 3-day history of forceful vomiting, headache, and reduced oral intake. Several times after vomiting, he had complained of numbness in his hands and feet that lasted several seconds. Two hours after receiving a dose of promethazine prescribed by his pediatrician, he could not be aroused by his parents. On arrival at the ED by ambulance, he is initially sleepy and confused. He is afebrile. His blood pressure is 99/74 mm Hg, heart rate is 89 beats/min, and oxygen saturation is 98% in room air. He has no dysmorphic features and no skin findings. His funduscopic findings and extraocular movements are …