6month old male child wt 6.5kg presented with 2days duration of bloody mucoid diarrhea followed by 3days constipation with abdominal distention.Mother gave child  herbal enema to aid bowel motion but was  unsuccessful .
Examination : RR 23 ,.HR140 Temp 37.2C     Irritable,  well hydrated, anicteric, Abdomen distended, tender all over, DRE : empty rectal  ampulla with bloody mucoid stains on finger
Diagnosis : Generalised  peritonitis  secondary to bowel perforation
Investigations :  Thoracoabdominal xray showed pneumoperitoneum
FBC Hb 11.1  WBC 17.63  PLT  979     Electrolytes Na 127 K 3.6 Cl 98  : Urea 2.51 creat 20 umol
Child prepared for lap after iv fluid resuscitation and antibiotics
Surgery : Exploratory laparotomy
Intra operative Findings  1. Pneuomoperitoneum
2. Faeculent peritoneal fluid
3. Ileocolic intussusception comprising terminal ileum, caecum, ascending colon, proximal transverse colon
4 . Multiple perforations on descending colon and proximal  sigmoid colon
Rt hemicolectomy with ileotransverse anastomosis was done
Left hemicolectomy with anastomosis of transverse and sigmoid colons done
Abdomen lavaged and closed
Postoperative state :Child made excellent recovery with no fluid or electrolytes derrangements, discharged day 11
Follow up: Child presented a month later with diarrhea for which a diagnosis of short bowel syndrome was made.  He was managed conservatively and discharged
Credits: Drs Michael Amoah( Paediatric surgeon ), Opuni ( Senior resident ) , Department of paediatric surgery, KATH , Kumasi
Permission was sought from parents before taking and  displaying the childs image.