Title : Spontaneous colonic perforation in a pediatric patient with acute febrile lllness: A case report
Abstract:
Background: Spontaneous colonic perforation is a rare but life-threatening surgical emergency, particularly uncommon in pediatric patients without predisposing conditions.
Case Report: We present a 4-year-old male admitted with acute febrile illness, suprapubic abdominal pain, and dysuria, initially managed as cystitis. Despite treatment, he developed diffuse peritonitis. Imaging revealed free subdiaphragmatic air suggestive of hollow viscus perforation. Exploratory laparotomy demonstrated ischemic ascending colon with a solitary cecal perforation. A right hemicolectomy with ileocolic anastomosis was performed. Histopathology showed nonspecific ileitis, typhlitis, and colitis with transmural inflammation, but no evidence of typhoid, tuberculosis, or inflammatory bowel disease. Postoperative recovery was uneventful with broad-spectrum antibiotics.
Discussion: Pediatric spontaneous colonic perforations are usually secondary to identifiable etiologies such as typhoid fever, tuberculosis, Hirschsprung’s disease, or inflammatory bowel disease. In the absence of such causes, idiopathic perforations are exceedingly rare. Our patient’s nonspecific febrile presentation initially mimicked a urinary tract infection, delaying diagnosis. This highlights the diagnostic challenge when non-specific symptoms mask underlying abdominal catastrophes. Early recognition and timely surgical management are crucial to reduce morbidity and mortality.
Conclusion: This case adds to the limited literature on idiopathic pediatric colonic perforation and underscores the need for high clinical suspicion in febrile children with abdominal pain. Prompt surgical intervention is vital for improved outcomes.
Keywords: Spontaneous colonic perforation, Pediatric acute abdomen, Ascending colon perforation, Right hemicolectomy, Idiopathic bowel perforation
