A 6-year-old girl presented with intermittent generalised abdominal pain for 2 days, associated with recurrent episodes of vomiting, without evidence of bloody, redcurrant stools or diarrhoea. An abdominal ultrasound revealed with a target-like mass in the right lower quadrant (Fig. la) consistent with an ileocolic intussusception. She underwent a successful air reduction, but developed a fever of 38.9°C and was admitted for observation. Initially, she was well appearing; however, she developed right upper and lower quadrant pain. An upright abdominal radiography was performed to rule out perforation or recurrence of intussusception. There was no evidence of perforation, but the abdominal X-ray demonstrated opacity in the right lower quadrant (Fig. lb). A repeat abdominal ultrasound revealed a dilated appendix, with significant inflammation and surrounding fluid suggestive of a ruptured appendix. She underwent a laparoscopic appendectomy during which she was confirmed to have a perforated retrocecal appendicitis. Postoperative course was notable for a paralytic ileus, which eventually resolved.
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