Chocolate Stick Causing Concealed Intestinal Perforation with no Signs of Peritonitis in a Child: A Case Report

Abstract

To highlight a very uncommon presentation of intestinal perforation in a child caused due to foreign body. 10-year-old kid presented to the emergency with chief complains of pain abdomen for 2 days. There was no evidence of any peritonitis. X-ray and Contrast enhanced computed tomography scan revealed no pathology other than gas under diaphragm. On exploration there was a concealed perforation caused due to chocolate stick ingested by the kid. There was no free fluid or contamination found in the peritoneal cavity. Foreign body ingestion by kids is very common. 80-90 % these objects pass with stool not causing any injury to the viscera. In 10 to 20 % cases they require endoscopic removal. 1 % of these cases can cause perforation and have to be removed surgically. Majority of the times these foreign bodies are not seen on X-rays or CT scans. There may be cases in which patients may not present with features of perforation peritonitis but still patients must be assessed properly to undertake intervention at appropriate time to reduce complication. In such children presenting to emergency with acute pain abdomen, a high degree of suspicion for foreign body ingestion should be kept in mind and evaluated accordingly. Keywords: Concealed perforation, Pediatric age group, No signs of peritonitis, X-ray, CECT Whole abdomen