Image of the Month—Quiz Case

A 12-year-old African girl presented with abdominal pain and intermittent fever of 3 weeks' duration. She had an unremarkable medical history. The pain had become more severe over the last 2 days and was associated with intestinal obstruction. The patient's temperature was 38.7°C, and her pulse was 113 beats/min. The abdomen was distended, with generalized tenderness. Bowel sounds were inaudible. Her white blood cell count was 8000/μL (to convert to ×10⁹/L, multiply by 0.001). Abdominal radiography showed intestinal occlusion with air under the diaphragm. A purulent peritonitis resulting from a punched-out perforation located on the antimesenteric border of the terminal ileum was visualized at laparotomy (Figure 1 and Figure 2).

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Figure 1. First operative view showing the punched-out perforation on the antimesenteric border of the terminal ileum associated with a purulent peritonitis.

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Figure 2. Second operative view of the same ileal perforation, associated with peritonitis and mesenteric nodes.

A.  Crohn disease perforation

B.  Typhoid intestinal perforation

C.  Traumatic perforation

D.  Ascaris perforation

Answer