Clinical problem-solving: three rare conditions--one pediatric surgical patient.

The purpose of this report is to demonstrate a step-by-step process of clinical decision making. A case study is presented in stages to simulate the way such information emerges in clinical practice. The focus is on the diagnostic process of this pediatric surgical patient's presentation, with particular attention to the unusual sequence of events and the diagnostic dilemmas that emerged for the clinicians involved. This case also represents three very rare conditions related to the same patient that have never been presented in the literature occurring in combination or in relationship to one another.