A 12 year-old-boy was taken to our hospital
with clear signs of acute abdomen. The abdominal findings were highly
suggestive of acute appendicitis with peritonitis.
The WBCs only slightly elevated at 8,000,
while fever was moderate (38°C).
The indication for surgery was unquestionable
and so we entered theater without any further imaging test.
The diagnosis of acute abdomen was actually
correct and at laparatomy we found fecaloid material in the peritoneal cavity.
To our surprise the appendix was completely
normal and there were no signs of appendicitis.
Therefore we have looked for the
possibility of perforated Meckel’s diverticulum, but the diverticulum was not
there. While checking the ileum for any sign of pathology, we have found a
small intestinal perforation at about 1 meter from the ileo-coecal valve.
The perforation was repaired.
Before washing the peritoneum with warm
water we have made sure there were no other perforations in the small intestine:
actually the perforation was solitary.
Before suturing, through the opening of the
intestine we had collected stool with a sterile syringe and sent it to the
laboratory for SSAg (Stool Salmonella Antigen): actually the result was
positive typhoid fever.
In the post-op the young patient has been
put on treatment with chloramphenicol and there were no further complications.
The case presented today reminds us that
intestinal perforation secondary to necrosis of the Peyer’s patches in severe
typhoid infection is always to be part of our differential diagnosis in case of
acute abdomen.
Bro Dr Beppe Gaido
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