Surgical experience with peptic ulcer in infancy and childhood

Abstract

In summary, sixty-eight cases of peptic ulcer in infancy and childhood are presented. The diagnosis was established by roentgenograms, autopsy or operation. The charts were carefully reviewed from the standpoint of age, sex incidence, precipitating factors, method of treatment and results. Particular attention is given to operative experience in twelve cases. Delay in surgical treatment was obvious and unavoidable in twenty patients (ranging in age from three days to five years) whose perforated ulcers was not diagnosed until autopsy. Two infants, seven weeks and thirteen months of age, survived closure of perforated ulcer diagnosed by roentgenograms. Each of these babies (Cases VI and XI) had adequate indication for operation because of massive hemorrhage and roentgenographic diagnosis of duodenal ulcer. Conservative treatment was advised in both cases by the surgical consultant until perforation had occurred. The thirteen month old infant had received 1,100 cc. of blood. An example of fatal delay in operative treatment is shown in Case XII, a three month old infant who had melena causing her hemoglobin to fall to 6 gm. per cent. Roentgenographic study indicated duodenal ulcer. In spite of continued bleeding, she was repeatedly transfused for six days, then operated upon.