Small bowel perforation

Case contributed by Dr Maulik S Patel

Presentation

Few days of fever followed by severe abdominal pain.

Patient Data

Age: 20 years
Gender: Male
Ultrasound

There is free intra-peritoneal gas anterior to the left lobe of the liver in the supine position. Free fluid with tiny echoes is present in the peri-splenic region, interbowel region and both iliac fossa. There are edematous small bowel loops in the lower abdomen. Mild splenomegaly is present.

X-ray

AXR in standing position

There is a rim of free intraperitoneal gas under domes of the diaphragm. There is no abnormal air-fluid level

Case Discussion

A young male presented with fever for last few days followed by severe abdominal pain. Ultrasound shows pneumoperitoneum, ascites with echoes, small bowel edema. Radiograph of the abdomen in the standing position shows free gas under the domes of the diaphragm. Exploratory laparotomy revealed a single perforation in the distal ileum. The cause of the fever was typhoid.

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Case information

rID: 65680
Published: 18th Jan 2019
Last edited: 20th Jan 2019
Inclusion in quiz mode: Included

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