A 16-year-old girl who was 4 months pregnant was seen at a hospital in Kenya. She presented with a 3-day history of abdominal pain, nausea and vomiting. Examination revealed a visibly ill young woman with a somewhat distended and generally tender, silent abdomen; the size of the uterus was normal for the stage of gestation. The laboratory work and clinical picture were indicative of generalized peritonitis. At laparotomy the abdomen was filled with purulent fluid. The pelvic organs (aside from the 4-month pregnancy), stomach, duodenum and appendix were unremarkable. Examination of the small bowel revealed a perforated Meckel's diverticulum, which was resected. On opening the resected specimen, a neatly curled and viable ascaris (roundworm) was found within the diverticulum. The patient received broad-spectrum antibiotics and antihelminthic treatment and made an uneventful postoperative recovery.
H.D. Hildebrand Emeritus Clinical Professor of Surgery University of British Columbia Vancouver, BC