Case reports Case 1

A 15 day old baby was admitted with a four day history of increasing vomiting and abdominal distension. After a normal pregnancy and birth he had been admitted to this hospital's special care baby unit for one day because of tachypnoea, grunting, and poor feeding. He had been circumcised by a local community rabbi at 11 days of age. Increasing vomiting and abdominal distension were subsequently noted, but he continued to feed well. His mother thought that he was passing urine normally.

On physical examination he had a pulse rate of 140 beats/min, warm hands and feet, a blood pressure of 77/52 mm Hg, and a respiratory rate of 28 per minute. The bladder was palpable above the umbilicus, but the abdomen wall was soft with normal bowel sounds. His penis was tightly bandaged, and the circumcision wound was inflammed and purulent. Table I shows the results of his initial renal function tests.