A 12-year-old African girl presented with abdominal pain and intermittent fever of 3 weeks' duration. She had an unremarkable medical history. The pain had become more severe over the last 2 days and was associated with intestinal obstruction. The patient's temperature was 38.7°C, and her pulse was 113 beats/min. The abdomen was distended, with generalized tenderness. Bowel sounds were inaudible. Her white blood cell count was 8000/μL (to convert to ×109/L, multiply by 0.001). Abdominal radiography showed intestinal occlusion with air under the diaphragm. A purulent peritonitis resulting from a punched-out perforation located on the antimesenteric border of the terminal ileum was visualized at laparotomy (Figure 1 and Figure 2).