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Life Threatening? No
Write-up: 4/21 - 10 week old male went for well care visit and got immunizations below. 4/28 - See H and P on additional sheet. Also progress in house. Patient is an 11 week old ex 37.4 week male infant. Prenatal care obtained, pregnancy reportedly unremarkable, infant born at Hospital. BW 2722 g. DC weight 2637 g. Baby exclusively formula fed with Enfamil GentleEase. Patient was well until approx 0300 on 4/27/14 when he vomited up his 0300 feed of 3 oz. His last "good feed" had been at 2100 the evening prior - 6oz. Parents later tried offering another 2 oz which he also vomited up. The called the advice RN who suggested PEDIALYTE via syringe. Parents tried all morning and initially it seemed to work, however he had an emesis at 1500 that appeared to be the entire volume of PEDIALYTE he had previously consumed. At that time he also had a ''wet fart'' that was bloody and mucous-like. Parents took him to hospital for evaluation at approx 1730 pm. There his stool guaiac was grossly positive. Labs as follows: CBC 14.4/1.9/36 Chem-7 133/5.2/102/23/14/0.4/93 C-reactive protein elevated at 11.2. Urine bag sample is pending. Stool cultures pending. ED unable to obtain IV access. Office contacted Pedi HBS for transfer and admission. KUB requested by MD. Reportedly unremarkable save a dilated loop of bowel in RUQ. No free air, no pneumatosis intestinalis. Allergies: No Known Allergies. Patient is a 5KG week old boy admitted at 1 AM from hospital with emesis. The emesis was copious, non-bilious, blood tinged. No pain to mom and dad''s recall. Has a 2 year old brother but no-one else ill in family. On exam he is afebrile, pulse 150, peeking out from blanket burrito. Well rehydrated with moist mucosa and Flat fontanelle. Abdomen soft, non-tender. No hernias. Normal anus. No labs recorded. We proceeded to UGI: Normal sized stomach (not large like seen with HPS). Normal ligament of Treitz location. Normal infant reflux. A/P: 11 week old with emesis. No evidence of the common surgical etiologies for this age such as HPS, volvulus, or incarcerated hernia. We then headed to US where intussusception was discovered. Proceeded on to BAE where intussusception confirmed but could not be reduced. To OR for laparoscopic, possible open reduction of intussusception with incidental appendectomy. 11 week old male presented with emesis and hematochezia. Malrotation and pyloric stenosis were ruled out with upper GI. Ultrasound showed intussusception, which was unable to be reduced by contrast enema. The patient was therefore taken to the operating room for laparoscopic exploration. Intraoperatively it was found that his intussusception had already reduced. Appendectomy was performed incidentally. Post-operatively, the infant had 2 normal stools and consistently passed gas. He tolerated regular feeds and was discharge home with parents, who are well aware of signs to watch for should he develop recurrent intussusception.
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