Case Presentation A 28-month-old male with a history of bronchial asthma presented to the emergency department with an acute onset of epigastric pain and recurrent blood-streaked vomiting that began earlier the same day. The child had been receiving oral corticosteroids for an asthma exacerbation and was also given four doses of over-the-counter ibuprofen syrup over the preceding four days for body aches.
Additional symptoms included low-grade fever and poor oral intake. Initial Examination Febrile: 38.3°C Tachycardic and signs of dehydration Abdomen: Generalized tenderness and guarding No abdominal distension Investigations Laboratory Findings: WBC: 24.6 × 10⁹/L (elevated) C-reactive protein: 68 mg/L (elevated) Procalcitonin: 2.2 ng/mL (elevated) Electrolytes: Hyponatremia and hypochloremia Imaging (Cover images A & B): Erect abdominal X-ray: Pneumoperitoneum (free subdiaphragmatic…
