This case involves a young boy who originally presented to the hospital with complaints of abdominal pain and fever. The patient was never given a proper workup and was discharged home that same day. He was brought back to the hospital a week later with a high fever, intractable diarrhea, and seizure-like activity. The patient was transferred to a tertiary care center where they finally diagnosed him with end-stage leukemia. The boy died several weeks later without ever receiving a full medical workup or disease intervention plan.
Question(s) For Expert Witness
- 1. What basic tests should have been ordered to rule out malignant disease?
Expert Witness Response E-004792
Abdominal pain in kids is a very common presenting symptom with a substantial differential diagnosis list. Occasionally it is indicative of a more serious medical problem. The evaluation of abdominal pain and fever is guided in part by the clinical picture. It’s really the fever in this setting that tends to make me a little more nervous. At a minimum, I would consider a complete blood count and urine studies to assess for infection or other inflammatory disorders. Serum chemistry would help define the degree of dehydration the patient might be suffering from as well as identify any metabolic derangement. In patients with a history of diarrhea, appropriate stool studies might be considered. X-ray studies may not be required based upon the exam and history. It is possible that earlier diagnosis could have changed the outcome for this patient.