Abdominal pain is a frequent complaint in the pediatric emergency department. A 13-year-old boy presented with complaints of abdominal pain, hematemesis, headache, and leg pain. Further investigation revealed an advanced-stage gastric adenocarcinoma with multiple thromboembolism including the greater saphenous vein and nonbacterial thrombotic endocarditis. This case points out the challenges of diagnosing this rare condition and treating the primary tumor and thromboembolism in the setting of both hypercoagulable state and gastrointestinal bleeding.

Max is a 3-year-old healthy boy who was brought to the pediatrician's office by his mother for frequent temper tantrums at home. His teachers at the Montessori school are concerned about his communication skills. He is very talkative with his peers, but he constantly speaks about Thomas the Tank Engine. His peers seem to be uninterested in his repetitive stories. His teachers believe that Max has difficulty separating fantasy and reality. At home, his mother describes Max as "difficult to control." When placed in time-out, he hits, kicks and scratches his mother. He has a large vocabulary, but mostly speaks in phrases directly from cartoons. For example, he repeats a particular phrase from a program in which the main character grows in size with fury every time he gets angry and says, "I hate it, leave me alone." Before this exposure, the mother reports that her son had never used the word "hate." Max watches 5 hours of children's programs on television every day; he is not exposed to any news programs. Frequently, he watches the same episode of a program many times. Max's mother believes that he can watch as much TV as he wants as long as it is "good programming," so he only watches PBS kids shows and the Disney channel.