The surgical treatment of perforated duodenal ulcer in the newborn

Abstract

The ninth reported survivor of a perforated duodenal ulcer in the newborn period is presented. Signs and symptoms became manifest from the forty-seventh hour after birth and surgical exploration with closure of the perforation was performed at fifty-seven hours of age. This is the first reported survivor in whom the ulcer was located in the second portion of the duodenum. Review of previously reported cases reveals: 1. 1. Duodenal ulcers in the neonate are acute in onset; clinically the complications are hemorrhage and perforation, with a somewhat greater tendency to the former, although these may occur together. 2. 2. As yet no distinct etiologic factor has been proved. 3. 3. The clinical picture of perforation is that of acute onset, with progression, of vomiting, abdominal distention, dyspnea and absent bowel sounds; evidence of gastrointestinal hemorrhage may be coincident. 4. 4. Roentgenograms, in all patients, are diagnostic of pneumoperitoneum. 5. 5. Early surgical closure of the perforation is the only hope for survival; no survivors are reported with nonoperative treatment. 6. 6. Careful exploration, plication of the perforation and toilet of the peritoneal cavity should be performed. 7. 7. The routine use of postoperative antibiotics is suggested.