Diagnosis: Abdominal pain
Treatment: Inpatient admission
The inpatient admission was medically necessary.
This little girl presented to the ED with prolonged gastrointestinal illness and resultant significant dehydration, raising concern for possible acute appendicitis. Comprehensive testing and surgical consultation in the ED did not reveal appendicitis. However, she continued to demonstrate multi-system involvement, with abnormal gait, initial refusal to walk, significantly distended urinary bladder with distended urinary collecting system, and elevated lipase. She had already been observed during her comprehensive evaluation in the ED and was not stable at that point for discharge home. While her symptoms and findings either improved (vomiting, fever, diarrhea, gait, ambulation, urination) or were not immediately retested (lipase) during her admission, the level of care needed to fully evaluate her and manage her symptoms was most consistent with acute inpatient.