An Incidental Finding of Hepatoblastoma Due to Bleeding After a Fall From Rollerblades

Abstract

A 10-year-old boy with no significant medical history presented for evaluation after an unwitnessed fall forward from rollerblades onto asphalt. The patient reported no loss of consciousness after the fall and was able to ambulate home. Within an hour, he had developed 3 episodes of nonbloody, nonbilious emesis, vague abdominal pain, and became sleepier, according to his mother. He was brought in by emergency medical services to a level 1 pediatric trauma center, with a cervical collar and backboard in place. He was given a fluid bolus and ondansetron en route to the center. Physical examinationOn arrival (about an hour after the fall), the patient was tachycardic (heart rate, 148 bpm) and tachypneic (respiratory rate, 24 breaths/min), with a normal blood pressure and oxygen saturation level.Findings from the physical examination revealed that the boy was well nourished and alert (Glasgow Coma Scale score, 15), but he was exhibiting excessive sleepiness. He also had generalized abdominal pain with minimal guarding but no distension or overlying bruising. The remainder of the physical examination was unremarkable.