Diabetic Ketoacidosis Misdiagnosed and Managed as Typhoid Ileal Perforation in a Ghanaian Child: A Case Report

Abstract

We report on a 15-year-old Ghanaian boy, who presented to a district hospital with diabetic ketoacidosis (DKA) but was diagnosed wrongly as a small bowel perforation due to typhoid fever. He presented with weakness, poor feeding, vomiting, and severe abdominal pain. General examination revealed a lethargic, drowsy, and severely dehydrated patient. His abdomen was diffusely tender more in the right ileac fossa. Investigations including complete blood count, blood smear for malaria parasites, urinalysis, and abdominal ultrasound yielded unremarkable results. Hemoglobin level was 12.4 grams per decilitre. He was diagnosed as typhoid ileal perforation and laparotomy was done, but the bowels and all other intra-abdominal organs were found to be normal. A blood glucose test was done intraoperatively, and it found very high hyperglycaemia. This led to the suspicion of DKA, which was confirmed through urine dipstick testing for high urine ketones and a high glycated hemoglobin (HbA1C) test result. He was then treated for DKA, which resolved on the second day of admission, but the surgical wound healed after twelve days.Our account emphasizes the need for testing for blood glucose in critically ill children and adolescents with suspected severe infections or acute medical conditions that require admission or surgical intervention. This owes to the fact that the clinical features of undiagnosed diabetes, especially if it progresses to DKA, are similar to those of infections and disorders managed via surgical treatment, which are rather more common in Ghana and Africa.