abdominal pain

A 4-year-old girl with progressive

abdominal pain

Question

A 4-year-old girl presented to the hospital with progressive abdominal pain and distention
after a 1-week history of watery diarrhea. The physical examination showed a body
temperature of 36.2°C, a distended abdomen, hypoactive bowel sounds, and diffuse
tenderness without rebound pain. The laboratory evaluation revealed a white-cell count of
5000 per cubic millimeter, with 63% segmented neutrophils,

What is the diagnosis?

Ankylosing spondylitis
Ascending cholangitis
Intestinal obstruction
Pancreatitis
Perforation of a viscus

Hide Correct.Answer

Correct Answer : Perforation of a viscus

Explanations :
The plain-film radiograph of the abdomen shows several signs of free intraperitoneal gas.
These include air accumulation in the right upper quadrant; the falciform-ligament sign,
visible as a longitudinal linear density on the ventral surface of the liver; the ligamentum
teres sign, visible as a linear density running along the inferior edge of the falciform
ligament; and the visualization of air on both sides of the bowel wall. The patient had a
perforated cecum.