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Write-up: Intussusception - 3 1/2 wks after rotavirus vax. 7-month-old female who was previously healthy who was transferred here from another hospital with complaints of vomiting and blood in her stool. Based on the mom''s history, the patient woke up two days prior to admission was some pain and screaming. She was given some TYLENOL to relieve the pain; however, this did not seem to improve anything. She was initially seen in the Emergency Department at an outside hospital and was diagnosed with an ear infection and given a dose of ROCEPHIN IM, as well as a course of amoxicillin. After three doses of amoxicillin, she returned to the Emergency Room at the outside hospital as she was vomiting every time her medications were administered. Mom also noticed a black stool on Monday evening, two days prior to admission, which she had attributed to her drinking red PEDIALYTE. The vomiting continued into the morning prior to admission when she was brought back to the hospital. By the evening on that day, she began to vomit, what appeared to be, coffee ground emesis. She began to become slightly more distended, and therefore, transfer was arranged to another hospital. The patient was initially admitted as a direct admission to the General Pediatric Service. She was started on PROTONIX 1 mg/kg IV with concern for gastrointestinal bleed. She was started on maintenance IV fluids and remained N.P.O. Gastroenterology was consulted for the concern for gastrointestinal bleeding. Review of outside films that came with the patient from the other hospital showed dilated loops of bowel in the mid abdomen. This was concerning for obstruction. This was communicated to the primary Team who, on hospital day number one, ordered a barium enema. An intussusception was identified at the level of the mid transverse colon and was reduced to the mid ascending colon. On a second attempt, this was further reduced to the level of the ileum. However, it was felt that there was likely a lead point or ileal intussusception, which was not reduceable by this barium enema. Pediatric Surgery was therefore consulted and reviewed the films. She was taken urgently to the Operating Room for an exploratory laparotomy with reduction of the intussusception. Intraoperatively, a large amount of distended ileum and distal jejunum was seen. These lead distally into an intussusception of the ileum into the more distal portion of the ileum. This was easily reduced with manual pressure. There appeared to be no lead point. There was some edema in the lead of the intussusception, but there is no other pathology as the cause for the intussusception. The bowel all appeared viable. For full operative details regarding this procedure, please refer to the operative note dictated April 24, 2008 by Dr. Patient tolerated this procedure well and returned to the Pediatric Surgery floor with a nasogastric tube in place. She remained N.P.O. on postoperative day one as her bowels continued to decompress. On postoperative day two, she was started on by mouth PEDIALYTE. She tolerated this quite well and on postoperative day three, was advanced to normal formula feedings. She tolerated both a four, as well as six ounce, feeding of her ENFAMIL GENTLE EASE formula without any emesis. Her belly remained soft and she was having bowel movements without any evidence of blood in it. At this time, she was felt stable for discharge with follow up in two week in Neurosurgery Clinic. 07/09/2008 VAERS report submitted with medical records attached for DOS 4/22-23/2008 and 4/23-27/2008 with D/C DX: Intussusception with Bowel Obstruction. Infant initially presented to local hospital for a 2nd time with vomiting dark brown emesis and black diarrhea stool-hemocult (+). Pt admitted and became increasingly listless with abdominal distention and continued dark emesis and blood streaked stool. Abdomen very tender to touch. Transfered to higher level of care where previous films were reviewed and Barium enema ordered which identified an Intussusception and was only able to partially reduce. Pt taken to OR for Exploratory Lap and reduction of IS. Pt initially NPO with NGT in place with po gradually introduced with no problems. Normal BMs. D/C home.
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