CASE
PRESENTATION
A 5-year-old boy with normal medical history was admitted to Haiphong
Children’s Hospital with abdominal pain around the navel at the
5th hour of the symptom. He also had a mild fever and
an inability to pass stool or gas. Physical examination: the boy was
conscious, able to communicate but tired, and suffering from a fever
(37,5oC). His pulse rate was 100 beats per minute; his
blood pressure was 90/60mmHg; the respiratory rate was 30 breaths per
minute. He stood at 100cm tall and weighed 18kg. All of these numbers
were in the normal range for his age. The abdominal examination noted
that he has abdominal distension and obvious abdominal muscle guarding
in the right iliac and umbilical region. His complete blood count: white
blood cell count was 14.8x109/l, neutrophils accounted
for 75.8%, serum CRP was 21mg/l. The abdominal ultrasound result showed
that his intestines contained fluid and increase motility. The abdominal
X-ray did not show abnormal images (See figure 1).
He was diagnosed with acute appendicitis and had had laparoscopic
surgery. We saw little fluid sticking around intestines through the
laparoscopic camera, with no pseudomembrane, no Douglas fluid, and the
appendix was normal. While examining the ileum, we did not found
Meckel’s diverticulums but a sharp foreign object that punctured the
intestine from the lumen of the intestine to the outside, about 35 cm
from the ileum – cecum (See figure 2, 3). After that, we removed the
foreign object, stitched the hole in the intestine, cleaned the abdomen,
and closed incisions.
The boy made a full recovery and was discharged in a satisfactory
condition following 7 days of treatment.