Unusual Presentation and Site of Small Bowel Perforation by
Case Report
An 80 year old man presented to our emergency department complaining of sudden onset abdominal pain around the umbilicus of two days duration. The pain was initially sharp and stabbing in nature then became dull aching continuous pain localized to the paraumbilical region. He had no vomiting or change of bowel habits. He was known to have hypertension on medical treatment and he had laparoscopic cholecystectomy 3 years ago and laparotomy for acute appendicitis with lower midline incision a year ago.
On clinical examination he looked well and was not in pain. Pulse was 86/minute, temperature of 38.7 °C, and BP was 160/96 mm of Hg. Abdominal examination revealed an area of redness and tenderness to the right of the umbilicus near the upper end of the laparotomy scar. There was no generalized abdominal tenderness or rigidity or others signs of peritonitis (Figure 1). ....