Case Report
N.T a seven year old girl presented to Hoima Regional Referral Hospital located in North Western Uganda as a referral from a district hospital following five days hospitalisation and treatment for malaria and septicaemia with antimalarial and antibiotics. She had been unwell for 13 days prior to admission with high grade fevers and abdominal pain. She had recently developed abdominal distension in the last two days. She had no history of yellowing of eyes. She reports episodes of loose motions and no constipation. Also her appetite was poor and the attendant reports she had lost some weight.
On examination she was febrile (38 degree Centigrade), mildly wasted, had no jaundice and was not dehydrated. On abdominal examination, the abdomen was moderately distended, she had generalised tenderness with rebound tenderness. Bowel sounds were reduced. A diagnosis of peritonitis was made and a laparotomy was scheduled. Chest Xray done was normal done was normal, complete blood count done showed leucocytosis and anaemia (8.0g/dl) and Widal test was positive.
At the laparotomy, we found oedematous, thickened bowel that was matted with purulent ascites of about 200mls, we found no gut perforation. We also found omentum adherent to the surface of the liver and a gangrenous gallbladder and a small gall bladder empyema of about 30mls of purulent fluid. We had difficulty dissecting the Calots triangle due to adhesions and necrotic gall bladder wall and decided to do a subtotal cholecystectomy with non-closure of the cystic duct. We left a sub hepatic and pelvic drain. On the second post-operative day the child developed a bile leak which was about 100mls per day in the early days and subsequently decreased. This we managed conservatively and were able to remove the sub hepatic drain 10 days later after which we discharged the child.