Hendrix is an 11-year-old male who presents with a 24-hour history of vomiting and abdominal pain.

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<p>Hendrix is an 11-year-old male who presents with a 24-hour history of vomiting and abdominal pain. There is no associated fever or diarrhoea.</p><p>The symptoms started about an hour after rugby training. He reports this is the second time in the past month that he’s had these symptoms after rugby training.</p><p>He engages in other regular exercise, including running and swimming, without incident.</p><p>There has been no clear precipitating injury or trauma preceding either episode.</p><p>Hendrix is usually well with no past history of note.</p><p>On examination, he is mildly tachycardic with otherwise normal observations, looks pale and uncomfortable, and is diffusely tender throughout the left abdomen, with some guarding in the left upper quadrant.</p><p>He is referred to ED, where an abdominal X-ray (pictured) is performed as a first-line investigation.</p>

Dr Kate Kelso is a GP and medical editor at Australian Doctor.