A 14-year-old girl presented with severe abdominal pain and bilious vomiting at our institute. Her symptoms first started 48 h after eating lunch. She had runny bowel movements twice daily; her bowel habits appeared normal to her and her family. Her past medical history included a low imperforate anus and spina bifida with a neurogenic bladder. At a different hospital, she was given oral antibiotics for a suspected urinary tract infection; at no time did she complain of dysuria.On arrival, she complained about worsened abdominal pain. She had mild lower-abdominal tenderness to palpation and rectal examination revealed a stenosed anus. Her vital signs were stable and she was afebrile. Urine analysis and laboratory studies were unremarkable. An abdominal X-ray (Fig. 1) showed massive dilatation of the colorectum and a partial asymmetric deformity of the sacrum. Magnetic resonance imaging (MRI) studies confirmed these findings and revealed a tethered cord.
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