A ten-year old male child, weighing 20 kg, was admitted through emergency with abdominal fullness and pain. There was a history of sustaining a trivial injury to abdomen two months back following which he developed mild abdominal pain. Intensity of pain increased gradually and became unbearable, along with abdominal distention. There was single episode of bleeding per rectum and off and on fever during this period with no other associated symptoms like vomiting and constipation. Past medical and family history was unremarkable.
Examination showed pale, anxious, thin built child with heart rate 120/min, respiratory rate 24 breaths/min, and temperature 101° F. Abdomen was protuberant, firm and severely tender. Digital rectal examination revealed a firm mass palpable on anterior aspect of rectal wall with mobile overlying mucosa, finger stall stained with blood.
Despite the history of trauma, signs and symptoms were more in favor of abdominal tuberculosis, with the differential of post traumatic infected haematoma, and sub acute or delayed presentation of infections like appendicitis and enteric fever. His haemoglobin was 7.8 g/dl, total leukocytes 14200/cmm, neutrophils 83%, ESR 10mm in 1st hour. Ultrasound abdomen showed moderate amount of fluid in abdomino-pelvic cavity. CT scan showed thick omentum, matted gut loops with lymphadenopathy and fluid collection in the peritoneal cavity (Fig. (Fig.1,1, ,2).2).