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Hematochezia in child

UnFiNiShEd CaSe CoMe BaCk LaTeR

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History of Present Illness:

A 1-year-old female is brought to the ED for intermittent pain causing her to cry followed by an episode of BRBPR.  She vomited once.  Mother denies any fever  or other complaints.  They recently returned from a trip to Puerto Vallarta, but no one else is ill.  Mother noticed her right nipple has a crack but didn’t see any bleeding

Vital Signs & Physical Exam:

Vital signs are normal.  Physical exam is otherwise normal except for the child seems quite tired.  Mom says it’s probably because she missed her nap yesterday and was awake a good portion of the night

Initial Differential Diagnosis: dysentery, intussusception, GI bleed, ingested maternal blood

Relevant Test Results:

  • Labs: none ordered
  • Imaging: See Below

QUESTIONS:

  1. What does the case image show?  
  2. What should you do next?  
  3. Want a 1-minute consult/tutorial on this case? 
  4. Want to know what happened with this patient?

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ANSWERS:

  1. What does the case image show?  The image shows intussusception
  2. What should you do next?  Enema reduction was unsuccessful.  Surgery was consulted and recommended transfer to the local children’s hospital
  3. Want a 1-minute consult/tutorial on this case?  See yellow area from sample page below.
  4. Want to know what happened with this patient?  See case conclusion below tutorial page.

1-Minute EM Consult on the topic for this case from the Emergency Medicine 1-minute Consult Pocketbook

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CASE CONCLUSION: Air enema reduction was successful at the children’s hospital.  The child was observed overnight, did well and was sent home after lunch the next day

CASE LESSONS:

  1. Always consider intussusception in a vomiting child, especially if younger than 2 years.  An early rectal exam may tip you off to the diagnosis.
  2. Never
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