Gastric ulcer in childhood; report of a case.

Abstract

The roentgen examination of the stomach and duodenum in infancy and childhood is usually concerned with congenital developmental abnormalities, hypertrophic pyloric stenosis, foreign bodies, and inflammatory lesions. Gastric ulcer is a rare condition in children, as indicated by the paucity of case studies in the literature, and its occurrence warrants reporting. It is to be expected that an increasing number of gastric and duodenal ulcers will be identified with more frequent use of radiographic diagnostic procedures in this group of patients. Foshee (2), in a review of the literature, found 18 cases of gastric ulcer in infants and children and added one of his own. Eleven of this series were diagnosed at surgery, 5 at autopsy, and 3 were identified by radiographic studies. Logan and Walters (3), in 1941, reported an additional 15 cases, in 12 of which radiographic studies were used in identifying the lesion. Bird, Limper, and Mayer (1), in an excellent review of the world literature, reported a total of 59 cases of gastric ulcer before the age of fifteen years as compared to 184 duodenal ulcers in a similar period. They further divided their cases into age groups, showing that only 6 cases of gastric ulcer were identified in patients from two to six years, while 16 have been reported between seven and eleven years of age. Case Report J. S., a white boy aged 6 years and 4 months, was admitted to Babies and Childrens Hospital of University Hospitals on Aug. 4, 1948, because of intermittent, vague, generalized abdominal pain of one week duration. This was associated with nausea, anorexia, and general malaise. There had been four episodes of vomiting beginning three days prior to admission. The vomitus was described as containing “black gravel.” The stool was examined prior to admission to the hospital by one of us (H. F. S.) and was found to be distinctly tarry, with a 4+ benzidine test. There was no fever, diarrhea, or history of bleeding tendency. The past history was non-contributory, and there was no history of ulcer in the family. The patient appeared well developed and well nourished, in no distress, and not acutely ill. His color was good, and there were no signs of hemorrhage in the skin or mucous membranes. Mild epigastric tenderness could be elicited on palpation of the abdomen. The temperature was 37.8° C., the pulse rate 108 per minute, respirations 18 per minute, blood pressure 140/80. The red cell count was 4,280,000, and the white cell count 13,100, with 70 per cent segmented neutrophils, 10 per cent stab cells, 14 per cent lymphocytes, 5 per cent monocytes, and 1 per cent eosinophils. Platelets numbered 265,200. The bleeding time was 2 minutes and 30 seconds; the clotting time 4 minutes and 55 seconds. The blood non-protein nitrogen was 31 mg. per 100 c.c. The blood Wassermann and Pangborn reactions were negative. The urine was normal except for a 4+ acetone reaction on admission, which disappeared on the second hospital day.