Spontaneous colonic perforation in a pediatric patient with acute febrile illness - Case report

Sep 30, 2026

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Spontaneous colonic perforation is a rare, life-threatening surgical emergency, particularly uncommon in children without predisposing conditions. The report presents a 4-year-old boy with acute febrile illness, suprapubic pain, and dysuria, initially treated as cystitis. Persistent symptoms progressed to peritonitis, and imaging showed free subdiaphragmatic air. Exploratory laparotomy identified an ischemic ascending colon with solitary perforation requiring right hemicolectomy. Histopathology showed nonspecific ileitis, typhlitis, and colitis without typhoid, tuberculosis, or inflammatory bowel disease, and recovery followed broad-spectrum antibiotics.

LanguageEnglish

CategoryHealthcare

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Abstract

Introduction

Case presentation

Journal of Surgical Case Reports, 2026, 1, rjaf1026 [https://doi.org/10.1093/jscr/rjaf1026](https://doi.org/10.1093/jscr/rjaf1026) Case Report Case Report Spontaneous colonic perforation in a pediatric patient with acute febrile illness: a case report Abhiraj Yadav 1 , *, Neha Arutla2 , Shreya Muddana2 , Hannah S. Jenifer2 , Malavath Sharath2 , Noorudin Ansari3 1 Manipal College of Medical Sciences, Emergency Medicine, Fulbari, Pokhara, 33700, Nepal 2 Mamata Academy of Medical sciences, General Surgery, Hyderabad, 500118, India 3 Department of General Surgery, Mamata Academy of Medical sciences, Fulbari, Hyderabad 500118, India *Corresponding author. Emergency Medicine, Manipal College of Medical Sciences, Pokhara 33700, Nepal. E-mail: [abhirajydv@gmail.com](abhirajydv@gmail.com) Abstract Spontaneous colonic perforation is a rare but life-threatening surgical emergency, particularly uncommon in children without predisposing conditions. We report a 4-year-old male who presented with acute febrile illness, suprapubic abdominal pain, and dysuria, initially managed as cystitis. Despite treatment, he developed peritonitis; imaging revealed free subdiaphragmatic air. Exploratory laparotomy showed an ischemic ascending colon with a solitary perforation, necessitating right hemicolectomy with ileocolicanastomosis. Histopathology demonstrated nonspecific ileitis, typhlitis, and colitis complicated by cecal perforation, with no evidence of typhoid, tuberculosis, or inflammatory bowel disease. Postoperative recovery was uneventful following broad-spectrum antibiotics. This case highlights the diagnostic challenge of spontaneous colonic perforation in children, where non-specific presentations may mimic urinary tract or infectious illnesses. Early recognition and timely surgical intervention are crucial to reduce morbidity and mortality. To our knowledge, this represents one of the few pediatric reports of spontaneous ascending colon perforation in the absence of identifiable etiology. Keywords: spontaneous colonic perforation; pediatric acute abdomen; ascending colon perforation; right hemicolectomy; idiopathic bowel perforation Introduction Spontaneous perforation of the colon is defined as a sudden perforation of an otherwise healthy colon in the absence of any predisposing disease or injury. The earliest case was described by Brodie in 1827, who reported a woman with spontaneous rectal rupture, and since then, fewer than 100 cases have been documented in the literature [1] . More than 60% of colonic perforations occur in the sigmoid or at the recto-sigmoid junction, most often along the anti-mesenteric border, making spontaneous cecal perforation a rare entity [2]. We report such a case that occurred spontaneously in a 4-year-old boy in a setting of acute febrile illness. Case presentation A 4-year-old male child, weighing 18 kg, was brought to the pediatric outpatient department with a 1-day history of fever and abdominal pain. He had been well until the day prior, when he developed a high-grade, intermittent fever associated with chillsand rigors. The fever was partially relieved by antipyretics, and the child remained active during afebrile periods. There was no associated rash. The abdominal pain was localized to the suprapubic region, dull and aching in nature, and was relieved following micturi- tion. It was accompanied by dysuria, characterized by burning sensation during urination, along with reduced frequency and quantity of urine. There was no hematuria, dribbling, or straining. A concurrent non-productive cough was reported, but there was no sore throat, vomiting, loose stools, or recent travel. Appetite was reduced, though no weight loss was noted. The child’s past history was notable for hospitalization with chickenpox 6 months prior. He was fully immunized for age, developmentally normal, on a mixed diet, and had no drug or food allergies. Family history was unremarkable for urinary

FAQs

What initial symptoms led clinicians to suspect cystitis in the child?

The child presented with acute febrile illness, suprapubic abdominal pain, and dysuria, with imaging initially suggesting cystitis and bladder findings consistent with that diagnosis.

What findings confirmed a perforation requiring surgery?

Despite treatment, the child developed peritonitis, and imaging revealed free subdiaphragmatic air. Exploratory laparotomy showed an ischemic ascending colon with a solitary perforation leaking fecal matter.

What did histopathology reveal and what etiologies were excluded?

Histopathology demonstrated nonspecific ileitis, typhlitis, and colitis complicated by cecal perforation. There was no evidence of typhoid, tuberculosis, or inflammatory bowel disease.

Sep 30, 2026

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