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Unusual presentation of much more popular disease/injuryCASE REPORTAtypical presentation of perforated peptic ulcer disease in a 12-year-old boySimon Mbarushimana,1 Gareth Morris-Stiff,two George ThomasCardiothoracic Surgery, Belfast, UK 2 Division of Common Surgery, Western Trust, Derry, UK 3 Department of General Surgery, Western Trust, Enniskillen, UK Correspondence to Dr Simon Mbarushimana, [email protected] Accepted 13 JuneSUMMARY A 12-year-old boy was referred for the surgical unit with 4 h history of severe reduce abdominal pain and bilious vomiting. No other symptoms were reported and there was no significant health-related or family history. Examination revealed tenderness within the reduce abdomen, in distinct the left iliac fossa. His white cell count was elevated at 19.6?09/L, with a predominant neutrophilia of 15.8?09/L in addition to a C reactive protein of 0.3 mg/L. An abdominal X-ray revealed intraperitoneal gas along with a chest X-ray identified free of charge air beneath both hemidiaphragms. Subsequent dia.