Abdominal Colic With Multisystem Involvement: a Case Report In A Female Adolescent With Suspect Gastritis, Urinary Tract Infection, And Severe Anemia

Abstract

Abdominal pain in children and adolescents requires a thorough evaluation, as it may be associated with gastrointestinal, genitourinary, or hematological disorders. This case report discusses a 13-year-old, 5-month-old girl who presented with intermittent left-sided abdominal pain lasting one week; the pain was described as stabbing, radiating to the back, and accompanied by fever, nausea, vomiting, diarrhea, and weakness. The patient had a history of hospitalization one month prior, with a diagnosis of ascites, suspected tuberculous peritonitis, and anemia. Physical examination revealed pale conjunctivae and mucous membranes, tachycardia, mobile and tender superficial auricular and cervical lymphadenopathy, epigastric tenderness, and hepatomegaly. Laboratory findings showed severe anemia (hemoglobin 5.9 g/dL) with normocytic red blood cell indices, thrombocytopenia (platelet count 31,000/µL), an elevated erythrocyte sedimentation rate, and hypokalemia. Urinalysis indicated microhematuria, with no evidence of leukocyturia, nitrites, or bacteria. An abdominal CT scan revealed hepatomegaly, signs suggestive of cystitis, and suspected duodenitis, with no ascites. The working diagnosis included abdominal colic—with suspected gastritis and a urinary tract infection (UTI)—hypokalemia, and severe anemia accompanied by thrombocytopenia. Management consisted of intravenous fluids, antibiotics, H₂-receptor antagonists, potassium correction, and a transfusion of packed red cells (PRC). Further evaluation is necessary to determine the etiology of the severe anemia and thrombocytopenia, and to confirm the suspected UTI—potentially through a urine culture. This case underscores the importance of a multisystemic diagnostic approach in adolescents presenting with abdominal pain and systemic symptoms, particularly when significant hematological abnormalities are identified.