Peritonitis secondary to ingestion of a cocoa bean: Case of a 2 years old infant

Abstract

Introduction: Foreign body ingestion is common among children under 3 years. While most pass through the digestive tract without incident, some may lodge in areas of narrowing or curvature, causing serious complications such as intestinal perforation and peritonitis. Diagnosis is often delayed as ingestion frequently goes unnoticed, particularly in rural areas with limited healthcare
access.

Case report: A 2 years old girl, daughter of cocoa farmers in Cameroon, was admitted to pediatric emergency for abdominal pain, fever, and vomiting evolving over 4 days. Examination revealed systemic inflammatory response syndrome and an irreducible inflammatory umbilical swelling. The initial diagnosis was herniary phlegmon on strangulated umbilical hernia. Emergency laparotomy revealed an ileal perforation 2cm from the ileocecal junction, exposing a cocoa bean. A right hemicolectomy with ileocolic anastomosis and hernia repair was performed. Postoperative course was marked by parietal suppuration on day 8 requiring local care and secondary closure, with discharge after complete resolution.

Conclusion: This case illustrates the diagnostic and therapeutic challenges of peritonitis secondary to foreign body ingestion in children. The absence of ingestion history and the atypical presentation associated with an umbilical hernia emphasize the importance of a high level of clinical suspicion. Prevention through parental education, optimization of the diagnostic pathway, and training medical personnel to recognize atypical presentations are essential to improve the prognosis of this potentially lethal condition.