#intussuseption

We had a 15 month old patient who was sent from his PCP to our ED to rule out intussusception due to bouts of intense, nonstop crying for 2 days. However, he had no diarrhea, constipation, vomiting, fevers, URI symptoms, history of trauma - nothing. His physical exam was normal, and workup for intussusception was negative, so the NP I was training with that day said without missing a beat, “let’s stain his eyes”.

A couple not-so-obvious differentials to keep in mind with infants who are inconsolable like our kid without any obvious pathology include:

• Corneal abrasion - Infants can’t tell you that it’s their eye that hurts, and there may be no other symptoms besides possible redness to the affected eye.

• Small fractures - Babies old enough to walk and explore fall down a lot. There is also the heartbreaking reality of child abuse. Though there may have been no obvious trauma according to the parent or guardian, a skeletal survey may be something to consider.

• Hair tourniquet - Examine fingers, toes, and penis for hairs strangulating the patient.

• UTI - Infants can’t tell you when it hurts to urinate, and parents may not always notice increased urinary frequency due to diaper use.

Our patient did end up having a pretty big corneal abrasion show up on fluorescein staining! I likely would not have thought to do this without furiously Googling what to do next, so I thought I’d share the clinical pearls I learned from this case.