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Life Threatening? Yes
Write-up: Intussusception. 5/15/07 Received medical records from hospital which reveal patient experienced 4 days of vomiting/obstipation. Exam revealed very distended abdomen w/umbilical hernia & rectal exam revealed no stool or blood. Admitted 3/13-3/25/07. Surgery for exp lap & noted to have ischemic terminal ileum w/ileocolic IS which was resected & anastomosis was performed along w/appendectomy & hernia repair. Continued to have significant abdominal distention, tachypnea & fever. Transferred to PICU & started on multiple antibiotics. Initial hospital course was rocky, requiring multiple fluid replacements & w/resp distress, was intubated & started on hyperalimentation via central line. Continued to have fever & was kept on antibiotics. Slowly fevers & dehydration resolved & he was extubated. Oozing from abdominal wound was noted along w/increased WBC. CT of abdomen showed no sign of obstruction or leak but did reveal inflammatory changes & fascial dehiscence. Taken back to OR & wound was reopened. Small amount of murky drainage was cultured & grew out pseudomonas & enterobacter, both sensitive to antibiotics he was already on. Retention sutures were placed & he was returned to PICU, extubated & slowly progressed to be afebrile w/oral feeds & normal bowel movements. Central line & TPN were d/c. D/C to home on oral feeds, topical wound management & off all antibiotics. FINAL DX:Ileocolic intussusception, & umbilical hernia, s/p bowel resection w/anastomosis, hernia repair & appendectomy.
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