I got an interesting case in ER
3.5 months old baby girl PMH significant for full sepsis workup at
birth due to Breathing difficulties and GBS positive mother. FT, NSVD
Present with lethargy and poor sucking, low temp according to mother.
No fever no vomiting or diarrhea perfectly fine till 2 hours prior to
On exam she was lethargic only responds poorly to painful stimuli,
pale dusky color with poor peripheral perfusion. V/S 158 pulse 32 RR
98.4 rectal Temp.
Pulse Ox 100%. low muscle tone had otherwise good reflexes and normal
Physical exam including abdominal exam. She was admitted in ICU.
initial lab results showed Normal CSF, BS 450, 17600 wbc, 10 Hb, 37.5
Hct 531 plt. UA normal ABG ph of 7.13
Next day in ICU she developed massive bleeding from IV sites .CT scan
of head and abdomen Negative DIC workup negative, including PT PTT
No rash. Surgery consult requested and kid was taken to OR turned out
to be Volvulus of Jejunum.
What is the possibility of Volvulus presenting like this?What should
we have done to had an earlier diagnosis? why should she have Bleeding
Appreciate comments.I would also appreciate literature regarding ER
presentation of volvulus in this age.
Brookdale University Hospital
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