Clinical Meeting

1. Presenters
Dr Maimuna Sayeed
Dr Romana Akter
Resident - Phase A
WELCOME TO
CLINICAL MEETING

2.  Name: Nafis
 Age: 3½ years
 Sex: Male.
 Address: Comilla
 DOA: 28/03/2016
 DOE: 29/03/2016
 Informant: Mother
Particulars of the Patient:

3. • Passage of blood just after passing stool for 1 year.
Presenting Complaint:

4. According to the statement of patients mother, her
son was reasonably well 1 year back, then child was
passing fresh blood at the end of defecation for 1 year.
The stool was not much hard and the child used to
pass stool 2-3 times per day. The passage of blood was
regular and passed drop by drop after each defecation
and it was not associated with pain. He was otherwise
active, playful and growing well.
History Of Present Illness:

5. There is no history of diarrhea, alteration of stool
colour, food allergy, oral ulceration, joint pain, fever,
weight loss or contact with TB patient. With above
complaints he got admitted to BSMMU for further
evaluation and management.
History Of Present Illness (contd.):

6.  Antenatal history: Uneventful, mother was on
regular antenatal check up.
 Natal history: He was delivered by LUCS at term with
birth weight 3.6 Kg and cried immediately after birth.
 Postnatal history: Uneventful
Birth History:

7.  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.

8. Family History: He is the 2nd issue of non-
consanguineous parents. There is no history of
similar illness in his family.
 Social & Personal History: He belongs to a middle
class family. They live in pacca house, use sanitary
latrine, drink tube well water.
 Drug History: Nothing significant

9. • Appearance: Well alert
• Anaemia: Mildly pale
• Jaundice: Absent
• Dehydration: Absent
• Oedema: Absent
• Cyanosis: Absent
• Clubbing: Absent
General Examination:

10. • 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.):

11. 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.):

12. Mouth and oral cavity: Healthy
Abdomen:
Inspection:
• Shape is normal,
• flanks are not full,
• Umbilicus centrally placed, inverted.
Palpation:
• Tenderness absent
• Organomegaly absent
Percussion: Tympanic
Auscultation: Bowel sound present
Alimentary system examination:

14. Nafis, a 3½ years old boy, 2nd issue of non
consanguineous parents, immunized as per EPI
schedule hailing from Comilla has admitted with the
complaints of painless per rectal bleeding in drop by
drop after each defecation for 1 year. His bowel habit
was regular, no h/o abdominal pain, diarrhea,
constipation, fever, oral ulceration, food allergy, weight
loss, contact with TB patient, no similar type of illness
in his family.
Salient feature:

15. On examination he was well alert, mildly pale, vital
signs were within normal limit, the anthropometry
revealed normal, DRE and systemic examination
revealed nothing abnormality.
Salient feature: (contd)

16. ?

17. Juvenile Colonic Polyp

18. 1. Meckel’s Diverticulum
2. Vascular Malformation
DIFFERENTIAL DIAGNOSIS:

19. 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).

20. • 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:

21. • 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)

22. Colonoscopy Report:

23. Juvenile Colonic Polyp

24. • Counseling
• Colonoscopic Polypectomy done and specimen sent
for histopathology.
Management:

25. S O A P
No complaints Appearance: well
alert
Afebrile
Pulse- 88b/min
Resr rate- 28br/min
Bowel- moved once
No passage of
blood
Static Discharge with
advice
F/U (04.04.16)