Jujube pit ingestion leading to ileal perforation and secondary acute appendicitis in a child: a case report

Acute appendicitis is a common pediatric surgical emergency. While most cases are primary, secondary appendicitis resulting from intra-abdominal pathologies like intestinal perforation is rare and diagnostically challenging. Sharp foreign body ingestion, such as jujube pits, can lead to intestinal perforation, peritonitis, and subsequent inflammation of adjacent organs, including the appendix.

We present the case of an 8-year-old boy who presented with a one-day history of migratory right lower quadrant abdominal pain, nausea, and high fever (39.2 ℃). Laboratory tests revealed markedly elevated inflammatory markers [white blood cell (WBC) 18.2 ×10⁹/L, high-sensitivity C-reactive protein (hs-CRP) 55.9 mg/L]. Abdominal computed tomography (CT) suggested a high-density shadow with intestinal perforation. An emergency laparoscopic exploration was performed, which revealed a large amount of purulent fluid, severe omental adhesion, and a perforation in the ileum approximately 10 cm proximal to the ileocecal (IC) valve caused by an impacted jujube pit. The appendix was congested and covered with purulent exudate. The patient underwent laparoscopic removal of the foreign body, wedge resection and anastomosis of the perforated ileum, and appendectomy. The postoperative course was uneventful, and the patient was discharged on postoperative day (POD) 12. Pathological examination confirmed acute suppurative appendicitis.

This case highlights that secondary appendicitis due to a perforated foreign body, though rare, should be considered in children presenting with acute abdomen and significantly elevated infection indicators, especially when the history of ingestion is unclear. Laparoscopic exploration serves as a valuable diagnostic and therapeutic tool for managing such complex cases. Timely surgical intervention to address the primary cause (foreign body and perforation) along with the secondary inflammation, followed by standardized postoperative care, is crucial for a successful outcome. This report also underscores the importance of parental education regarding the prevention of foreign body ingestion in children.