PE reveals no changes except some voluntary guarding over the supra-pubic area. Child is given IV fluids for 2 more hours, voids and feels somewhat improved. PE is unchanged. Child is discharge with a dx of viral syndrome. Rx changed to oxycodone.
Child persists with nausea and vomiting the next day and the develops lower abdominal pain.
Several case reports detail the association of urinary retention and acute appendicitis in children. Brought in by both parents stating that their 8 month old German shepherd puppy had pounced on their infant and 'tossed him about like a toy'. CT scan of brain is normal. Parents refuse admission for observation. Metro interviews family, checks out their apartment.