A Critically Ill Child with Gangrenous Appendicitis Masquerading as Hollow Viscous Perforation

BACKGROUND: Severe complications of acute appendicitis (AA) hitherto well described are less common in clinical practice nowadays. When a septic child is encountered with a short history of abdominal symptoms and disproportionate signs of peritonitis further complicated by radiological findings causing a diagnostic conundrum, management becomes exceedingly demanding. Case Presentation. A 10-year-old previously healthy boy presented to the emergency room with generalized abdominal pain associated with fever and jaundice for a day. Blood workup revealed leucopenia, hyperbilirubinemia, hyponatremia, and elevated CRP. Initial radiological evaluation suggested hollow viscous perforation. He was diagnosed to have hollow viscous perforation peritonitis in severe sepsis. At laparotomy, generalized peritoneal contamination was found, the source of which could be traced down to the gangrenous perforated appendix. CONCLUSION: Complicated appendicitis, in children, can present with baffling findings. Timely identification of an ill child, adequate workup, prompt resuscitation, and source control are imperative for a successful outcome.