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.