Male patient, 18 months old.
The patient's family history included a 5-year-old brother diagnosed with irritable colon and gastroesophageal reflux.
It was born by spontaneous delivery of vertex and at term.
Birth weight 3450 g.
Normal ultrasound, hearing and metabolic neonatal screenings.
She received exclusive breastfeeding up to 5 months of age, with adequate weight and height development up to that age (P25).
Coinciding with the introduction of artificial feeding starts a picture of slow digestive vomiting and digests.
Suspected gastroesophageal reflux disease starts treatment with the monthsmperidone, being unfavorable evolution, so milk is changed to a protein hydrolyzed and is referred to the pediatric gastroenterology consultation 7
The pH-metry is normal and allergy to cow's milk proteins is ruled out.
The poor clinical evolution persists.
The percentile curve in weight and height deduces to be between P10 and P3 and at the same time becomes a frequent patient in the Emergency Departments.
At 12 months she was admitted due to acute gastroenteritis and malnutrition grade I. Among the multiple diagnostic tests an abdominal ultrasound was performed which was informed of adenopathies and as a digestive tract examination up to 12 mm. A new pH monitoring was performed.
Upon discharge, the patient was fed with a hypercalorie mixture, and received amperidone.
The patient had a poor outcome and was readmitted 18 months later due to vomiting without oral tolerance.
Physical examination revealed subicteric skin dye.
The biochemical study is normal, but a new ultrasound examination is again requested, emphasizing vomiting together with the subicteric skin dye.
Ultrasound evidences, at the level of the gallbladder, two echogenic bodies producing acoustic shadowing compatible with gallstones.
After laparoscopic cholecystectomy, the child starts a picture of pondostatural recovery together with the disappearance of vomiting and the rest of the accompanying symptomatic courtship.
