Age: 0.5
Sex: M
Vaccine: DTAPHEPBIP, FLU4, PNC13, RV5
Symptoms: Blood ketone body, Crying, Enema administration, Eye movement disorder, Full blood count
Clinical narrative: Intussusception of intestine. As per Dr., "Patient is a 6mo, ex-term, previously healthy M who presented to hospital last night after having about 1 hour of acute-onset fussiness and crying, started around 10:30pm yesterday evening. At hospital abdominal ultrasound was suggestive of intussusception, so patient was transferred to another MC for further evaluation. Mom reports patient was in his usual state of good health and had a normal breastfeed last night around 9:30 pm. She went to put him to sleep at approximately 10:30pm and he started screaming and crying. MOC reports this was not his typical cry. Episodes of inconsolability lasted several minutes and there were short periods of calm/quiet in between. Parents initially thought maybe this could be gas pain, since patient tried several new foods the day prior during holiday meal. However, when the episode of screaming/crying did not quickly resolve they brought him to the ED. In the ED, patient had normal vitals and apparent decreased bowel sounds on exam. He had CBC, CMP, lipase, acetone level, abdominal ultrasound, PIV placement, 20mg/kg NS bolus and was given 0.025mg/kg of morphine x 2. See results below. Patient had emesis x 1 in the ER. Case was discussed with Dr who accepted patient for transfer, as well as another Dr and myself. Patient and mom were flown by fixed-wing plane for admission to MC. Transfer was uneventful. MOC reports that patient had a large BM several hours before pain episode began. This was normal in color and consistency. Mom has never seen any blood in patient's stool. He has had no fever and no history vomiting (though did have large-volume emesis in the ER that had the appearance of formula). Did develop some mild rhinorrhea several days ago but no cough or respiratory distress. Imms are UTD - did get 6mo vaccines and flu shot 5 days ago. Development and growth have been normal. Eats well at breast and formula by bottle when mom at work. Taking some solids. No sick contacts. Not in daycare. Of note, MOC reports that about 2mos ago patient began having clustered episodes of abnormal eye movements described as eyes rolling back and moving rapidly from side-to-side. Episodes last less than 1 min, then occur again several minutes later. Previously clustered episodes occurred daily or every-other-day. Patient had an EEG 6wks ago that was reportedly unremarkable. Episodes have not occurred over the last month but recently started up again. They have been referred to see Dr in our pediatric neurology clinic but have not been successful at making an appointment yet. There is no FH of seizures. Patient has not had any abnormal movements elsewhere in the body, only his eyes." Patient was admitted to the pediatric floor, where radiology performed a beside US which confirmed ileocolic intussusception. Patient was taken to the radiology suite, where he underwent a successful reduction by air enema. He returned to the floor where he remained clinically stable for the next 24 hours. His diet was advanced which he tolerated without increased pain and appropriate urine output. Radiology requested repeat US, which was obtained 6 hours post reduction and normal. Etiology of patient's intussusception was felt to be secondary to recent Rotavirus vaccine. Will discuss with PCP on Monday with attempt to obtain vaccine information for reporting purposes. Patient was not witnessed to have eye rolling or seizure-type activity during his observation period. Outpatient peds neurology follow-up was scheduled as below. Return precautions were discussed with family prior to discharge.