A 11 months old boy presents to the emergency department with diffuse abdominal pain that is worse with bowel movements. The child has no urinary symptoms. The pain started 43 hours ago. He has no history of fever and has had no vomiting with hard stools with frequent encopresis. Is stooling twice a week. Has no known sick contacts.

Past Medical History:

Past medical history is is significant for being a picky eater with a history of poor fluid intake. Has had mild, episodic abdominal discomfort for several months. Immunizations are up to date. The child is on the 50th percentile for weight and growing well.

Family / Social History:

Family history is unremarkable. Social history is negative. 

Physical Exam:

On physical exam the patient appears well. Abdominal exam reveals palpable stools and anal fissures.

Labs:

Bloodwork:

WBC: 11.7x109/L

Platelets: 170x109/L

Hemoglobin: 126 g/L

MCV: 83 fL

C-reactive Protein: 4 mg/L

Imaging:

Abdominal Xray: Fecal loading