A previously healthy 3-year-old female presented to our pediatric clinic with two days history of high temperature 38- 40 c Mother gave ibuprofen susp. With diclofenat in alternative way aiming to control temperature . On the second day the mother asking to medical advice for this illness and she was diagnosis as acute tonsillephyrgitis and azithoromcin described to ttt the infection At that time only the increase in temperature & mild abdominal pain there is no vomiting or diarrhea At night the mother called here doctor prescribing a bloody stool twice with no vomiting or colic He ask the mother to do abdominal ultra sound & erect X RAY for her daughter But the results was –ve nothing wa found to explain the bloody stool He ask here to make alab evaluation for C B C &stool analysis On the third day she pass a fleshy, bulky bloody mass twice was passed one of them referred 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 intussusception but 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 signs of intussusceptions so the decision was wait 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 consultant for revaluation Drug induced GIT BLEEDING

1. Dr.Osama Arafa Abd EL Hameed
Consultant
of
Pediatrics & Neonatology
Head of Pediatrics Department
Port-Fouad Hospital
Case Presentation
Port Fouad pediatric department
By

2. • 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

3. • 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

5. • 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 .

10. • 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

11. • 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.