Pneumoperitoneum: An unusual presenting finding of perforated appendicitis in children

Abstract

Pneumoperitoneum is rarely encountered as a radiographic finding in association with perforated appendicitis in children, and may lead to diagnostic errors. In this paper, we present pneumoperitoneum as a presenting finding of perforated  appendicitis in a 2-year-old boy. The term pneumoperitoneum frequently indicates perforation of an intra-abdominal hollow viscus. However, it is rarely encountered as a radiographic finding in association with perforated appendicitis. The cases reported in the literature are mostly adult patients, but the relevant data in children are limited. Here, we present a case of a 2-year-old boy with perforated appendicitis who presented with pneumoperitoneum. The patient was taken into the operation theater with an initial diagnosis of gastrointestinal perforation. Surgical exploration indicated a perforated appendix and an appendectomy was performed.  Appendicitis is one of the most common surgical abdominal emergencies in children. However, very young children often pose a diagnostic dilemma for the clinician.  Pneumoperitoneum is a confusing finding in perforated appendicitis, and may lead to diagnostic errors. However, it may be considered as a favorable sign because it will result in the patient’s immediate surgical exploration and cure.

Keywords: appendicitis, children, pneumoperitoneum