Introduction: Recurrent abdominal pain is defined as episodes of pain occurring atleast monthly for three consecutive months with a severity that interrupts routine functioning. Pain is classified as either organic or non organic, depending on whether a specific cause of the pain is identified. Aims and Objectives: To determine the etiological spectrum of recurrent abdominal pain in 5-15 years old children coming to the paediatric outpatient on the basis of first line investigations ie urine analysis, stool analysis and ultrasound abdomen and to study the incidence of irritable bowel syndrome according to ROME III Diagnostic criteria. Design: Prospective observational study. Setting: Tertiary level teaching hospital. Methods: A total of 100 children with recurrent abdominal pain were enrolled, detailed history, general and systemic examination was done. Urine and stool routine microscopy and ultrasound abdomen was performed. Patients were differentiated into organic, functional and irritable bowel syndrome. Results: Out of 100 children with RAP 84 were in 5- 10 years age group and 16 where in 11-15 years, with slight male preponderance (53%). The site of pain showed that 43 had epigastric pain, 28 had in lumbar region, 20 in umbilical region and 4 in iliac fossa. In associated symptoms fever was present in 32 children, vomiting in 43, loose motions in 27 and abdominal distension in 15. Pain in relation to food intake is found in 32 children, 14 had aggravation and 18 children had relief. UTI was found in 11 cases and worm infestation in 10 children, 8 had Ascaris infestation, 1 each had hook worm and giardia infestation. USG abdomen showed renal calculi in 10 children and free fluid in the pelvis in 3 children. Thirty four children revealed an organic cause from the basic investigations, 12 could be classified as IBS. Conclusion: First line investigation can lead to a diagnosis in one third cases of abdominal pain in children and in the remaining as of non-organic causes. 12% were diagnosed as IBS as per Rome3 criteria in the present study.

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Ataxia telangiectasia (A-T) typically presents with early-onset progressive cerebellar ataxia, oculomotor apraxia and later, oculo-cutaneous telangiectasia. This report is about an 8-year-old boy who presented with severe progressive dystonic posturing. On ocular examination, tortuous blood vessels were noted on lateral bulbar conjunctiva of both eyes. Magnetic resonance imaging showed cerebellar atrophy and Serum alpha-fetoprotein level was 83IU/L. The Serum IgA level was less than 6.63mg/dl, Serum IgE was 3.31IU/ml (N=10IU/ml). Patient responded to Syndopa (1mg/kg/d) and the cerebellar signs were unmasked when dystonia was controlled with drugs. As dystonia was the main presenting feature in this case of AT, doctors should be reminded that AT can present as “Dystonia telengectasia” (DT).

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We report a 9-year-old male child with hypothyroidism and limb muscle pseudohypertrophy i.e. Kocher-Debre-Semelaigne syndrome (KDS), which is a rare clinical presentation. It is the type of myopathy associated with severe and long standing hypothyroidism. Pseudomuscular hypertrophy is reversible with entrain treatment.

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Enteric fever presentation may vary from mild illness to severe life threatening complications. A 12 year old girl admitted with high grade fever for one week with abdominal pain later on developed circulatory collapse and myocarditis with AV block. She had no previous history of heart disease or any other significant illness in the past. Although cardiovascular collapse is frequently seen in complicated typhoid fever, the development of toxic myocarditis with AV block is a rare complication. The child was treated with antibiotic, inotropic, and chronotropic support, temporary pacemaker implantation along with judicious use of corticosteroids. She was discharged after 2 weeks of admission in a stable condition.

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We report a 9 month old boy with isolated bilateral congenital proximal radioulnar joint osseous synostosis presenting with limitation of supination of the forearm.

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