Spontaneous colonic perforation in a pediatric patient with acute febrile illness: a case report.

Spontaneous colonic perforation is a rare but life-threatening surgical emergency, particularly uncommon in children without predisposing conditions. We report a 4-year-old male who presented with acute febrile illness, suprapubic abdominal pain, and dysuria, initially managed as cystitis. Despite treatment, he developed peritonitis; imaging revealed free subdiaphragmatic air. Exploratory laparotomy showed an ischemic ascending colon with a solitary perforation, necessitating right hemicolectomy with ileocolic anastomosis. Histopathology demonstrated nonspecific ileitis, typhlitis, and colitis complicated by cecal perforation, with no evidence of typhoid, tuberculosis, or inflammatory bowel disease. Postoperative recovery was uneventful following broad-spectrum antibiotics. This case highlights the diagnostic challenge of spontaneous colonic perforation in children, where non-specific presentations may mimic urinary tract or infectious illnesses. Early recognition and timely surgical intervention are crucial to reduce morbidity and mortality. To our knowledge, this represents one of the few pediatric reports of spontaneous ascending colon perforation in the absence of identifiable etiology.