Hot Seat #40: 3 yo with bloody stoolsPosted on: June 23, 2014, by : Sonny Tat MD MPH
3 year-old previously healthy girl presents to your ER with abdominal pain and bloody stools. The patient had abdominal pain starting yesterday. After a few hours, the patient had a bowel movement with dark red blood, which may have eased the pain. She had two or three more episodes of bloody stool and intermittent abdominal pain yesterday. Today she went to the PMD who sent stool studies and sent her home. She is in the ED today because of persistent abdominal pain that puts her in the fetal position that is temporarily relieved by bowel movements that are associated with dark blood. She has had emesis x 2 today that is non-bloody, non-bilious.
ROS: No fevers, rash, constipation, sick contacts, or change in diet. URI two weeks ago.
Exam: VS Afebrile, HR 119, RR 22. BP 97/57
Well-appearing, active, smiling, no distress
Chest CTAB, heart RR, no murmurs or gallops
Abd ND/NT, no masses. Rectal exam shows gross blood at the anus
Hemoglobin 8.8 WBC 11.7 Platelets 302 MCV 79
Na 139 K 3.4 Cl 106 CO2 22 BUN 11 Cr 0.4
Ultrasound is negative for intussusception
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