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Puzzling peritonitis in an adolescent
  1. Alasdair Munro,
  2. Mark Tighe
  1. Poole Hospital NHS Foundation Trust, Poole, Dorset, UK
  1. Correspondence to Dr Alasdair Munro, Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, Dorset BH15 2JB, UK; a.munro{at}

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A previously well 15-year-old boy presented with sudden onset, central abdominal pain, generalised tenderness and absent bowel sounds. Despite supportive management, he became shocked and pyrexial. Appendicitis was excluded by clinical examination; however, given the abdominal signs, further imaging was sought after a joint paediatric and surgical review. Abdominal ultrasound scan identified free intra-abdominal air, following which a CT scan was arranged. …

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