Dr.Osama Arafa Abd EL Hameed

Consultantof

Pediatrics & Neonatology

Head of Pediatrics Department Port-Fouad Hospital

Case Presentation

Port Fouad pediatric department

By

• A previously healthy 3-year-old female presented to our hospital pediatric clinic with two days history of high temperature 38- 40 c

• Mother gave her ibuprofen susp. With diclofenat in alternative way aiming to control temperature but she become alert & asking for medical advise

• On examination nothing is relevant & her abdomen was lax at the time of examination and no palpable masses

• She was diagnosed as acute tonsillophyrgitis and azithoromycin was prescribed to ttt the infection & for follow up after 3days

• At that time only increase in temperature & mild abdominal pain with no vomiting or diarrhea

• At 3rd. night the mother called her doctor describing a bloody stool twice with no vomiting or colic

• He asked the mother to do abdominal ultra sound & Erect X RAY for her daughter

• But the results was –ve nothing was found to explain the bloody stool

• He asked here to make a lab. evaluation for C B C &stool analysis

• On the 4th day she pass a fleshy, bulky and bloody mass, twice., it was token to pathology lab.

• the patient was referred to be evaluated by surgeon who ask to repeat the ultrasound and the results referred to signs of intussusceptions

although there is no any clinical signs of obstruction like

vomiting or bouts of colic she referred to Cairo for further evaluation .

• Ultrasound was done for the third time but surprising us There is no any suggestive clinical signs of intussusceptions .,

so the decision was postpone waite and see with the time no blood in stool general condition improved

with time temperature disappeared

• So she was referred to PEDIATRIC G. I .T consultantion for revaluation or for further investigations.

• The provisional diagnosis was drug induced bleeding by this evolution of G I T consultant & Ranitidine was prscribed for 2 weeks

• The history and physical examination of a patient remain the cornerstones of clinical medicine. Without an adequate history and physical examination to suggest possible differential diagnoses, the subsequent investigations of the patient may be endless.

• "Always listen to the patient, they might be telling you the diagnosis." Attr. William Osler

• Don’t trust your investigations if there is a clear controversy with the clinical examination & the condition of your patient.

Take home message

THANK YOU