Case 4: Faulty Feeding Habit (by Yeung, Chap-Yung)

Patient: 8 month old boy
Source: Hong Kong, 1993
Presenting features:
	Vague ill-health with intermittent irregular bowel habits and vomiting for 4+ weeks. Fever x 3+ weeks.
When examined:
	Abdomen: distended with gases + some ascites. Click to Enlarge Doughy feeling with mild rebound tenderness. Patchy gut-matted together.
Relevant Investigations:
	Tuberculin skin test +++.
	CT abdomen: lymph nodes enlargement and thicken bowel wall.
Diagnosis:
	Tuberculosis of Abdomen ( Enteritis + peritonitis ).
Background:
	Grandmother had pulmonary TB, treated in Mainland China for 2 months 8 years ago. She was noticed to put teaspoonful of hot congee into her own mouth to ensure it was not scalding before feeding the baby.
Lessons:
1)	It is highly possible the cultural practice to prevent scalding the infant with hot food might have been responsible for the child's disease.
2)	TB abdomen, though rare in the English literature, is not that uncommon among Chinese.
3)	Doughy feeling of the abdomen in a febrile child should alert the possibilities not only of TB but also enteric fever ( typhoid ).