Presenters

Dr Maimuna Sayeed

Dr Romana Akter

Resident - Phase A

WELCOME TO

CLINICAL MEETING

Name: Nafis

Age: 3½ years

Sex: Male.

Address: Comilla

DOA: 28/03/2016

DOE: 29/03/2016

Informant: Mother

Particulars of the Patient:

• Passage of blood just after passing stool for 1 year.

Presenting Complaint:

According to the statement of patients mother, herson was reasonably well 1 year back, then child waspassing fresh blood at the end of defecation for 1 year.The stool was not much hard and the child used topass stool 2-3 times per day. The passage of blood wasregular and passed drop by drop after each defecationand it was not associated with pain. He was otherwiseactive, playful and growing well.

History Of Present Illness:

There is no history of diarrhea, alteration of stoolcolour, food allergy, oral ulceration, joint pain, fever,weight loss or contact with TB patient. With abovecomplaints he got admitted to BSMMU for furtherevaluation and management.

History Of Present Illness (contd.):

Antenatal history: Uneventful, mother was onregular antenatal check up.

Natal history: He was delivered by LUCS at term withbirth weight 3.6 Kg and cried immediately after birth.

Postnatal history: Uneventful

Birth History:

Developmental History: His development is age appropriate.

Past Illnesses: Nothing Significant.

Immunization: Immunized as per EPI schedule.

Feeding History: Exclusive Breast fed up to 6 months, now he is on family diet.

Travel History: Nothing contributory.

Family History: He is the 2nd issue of non-consanguineous parents. There is no history ofsimilar illness in his family.

Social & Personal History: He belongs to a middleclass family. They live in pacca house, use sanitarylatrine, drink tube well water.

Drug History: Nothing significant

• Appearance: Well alert

• Anaemia: Mildly pale

• Jaundice: Absent

• Dehydration: Absent

• Oedema: Absent

• Cyanosis: Absent

• Clubbing: Absent

General Examination:

• Koilonychia: Absent

• Leuchoychia: Absent

• Lymph node: Not palpable

• Skin survey: Normal

• BCG mark: present

• Eye and ENT: Normal

• Digital rectal examination: No abnormalities found

General Examination (Contd.):

Vital signs:

Temp: 98˚F

Pulse: 92b/min

Resp. rate: 32br/min

Anthropometry:

Height : 98 cm (50th centile)

Weight: 14 Kg (25th centile)

General Examination (Contd.):

Mouth and oral cavity: HealthyAbdomen:Inspection:• Shape is normal,• flanks are not full, • Umbilicus centrally placed, inverted.Palpation:• Tenderness absent • Organomegaly absentPercussion: TympanicAuscultation: Bowel sound present

Alimentary system examination:

Nafis, a 3½ years old boy, 2nd issue of nonconsanguineous parents, immunized as per EPIschedule hailing from Comilla has admitted with thecomplaints of painless per rectal bleeding in drop bydrop after each defecation for 1 year. His bowel habitwas regular, no h/o abdominal pain, diarrhea,constipation, fever, oral ulceration, food allergy, weightloss, contact with TB patient, no similar type of illnessin his family.

Salient feature:

On examination he was well alert, mildly pale, vitalsigns were within normal limit, the anthropometryrevealed normal, DRE and systemic examinationrevealed nothing abnormality.

Salient feature: (contd)

?

Juvenile Colonic Polyp

1. Meckel’s Diverticulum

2. Vascular Malformation

DIFFERENTIAL DIAGNOSIS:

Points in favour Points against

Juvenile Rectal polyp Age: 3½ yrs.Painless per rectal bleeding after passing of normal stool.Well thriving.

Meckel’s Diverticulum Painless per rectal bleeding.

Bleeding occurs drop by drop(small amount).

Vascular Malformation Painless per rectal bleeding.

Bleeding occurs drop by drop(small amount).

• CBC

Hb: 11.1 g/dl

ESR: 20mm in 1st hour

WBC (TC): 8.8x10^9/L

N: 30%, L:54%

• Stool R/E

Epithelial cell: nil

RBC: nil

Pus cell: nil

Investigations:

• Stool C/S: no growth

• CRP: 3.3 mg/L

• Plain X-ray Abdomen erect posture: normal study

• Colonoscopy: A pedunculated polyp is found 20 cm from anal verge.

Investigations: (contd)

Colonoscopy Report:

Juvenile Colonic Polyp

• Counseling

• Colonoscopic Polypectomy done and specimen sent for histopathology.

Management:

S O A P

No complaints Appearance: well alert AfebrilePulse- 88b/minResr rate- 28br/minBowel- moved onceNo passage of blood

Static Discharge with advice

F/U (04.04.16)