Abstract
ObjectivesPerforated peptic ulcer (PPU) is a rare but life-threatening surgical emergency in childhood. The aim of our study was to analyse the clinical features, diagnosis and management of PPU in children.MethodsThe data of children diagnosed with gastroduodenal PPU at Children’s Surgery Department, Children’s Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos from 1994 to 2012 were reviewed. The patients’ age, sex, anamnesis, clinical features, examination results, operative findings and methods, medication therapy and outcomes were assessed. Statistical analysis was performed using MS Excel.ResultsThere were 14 (93.3%) males and one female aged 14 to 18 years (16.3 ± 1.3) included in the study. Twelve patients (80%) were diagnosed with gastric and 3 (20%) with duodenal PPU. Eleven patients (73.3%) had dyspepsia before PPU, of them 4 had a history of peptic ulcer disease. Most patients (46.6%) arrived to the hospital within 6 hours of symptom onset. All presented with severe epigastric pain, 8 (53.3%) with nausea and vomiting. Only one patient (6.6%) complained of melena. One (6.6%) suffered from epigastric pain radiating to the left shoulder. Physical examination revealed positive peritoneal signs in 13 patients (86.6%). Subdiaphragmatic free air was detected in 12 patients (80%). The mean duration of perforation was 34.47 ± 57.41 hours (2–178). Thirteen patients (86.6%) underwent laparotomy, 2 laparoscopic repair. The anterior wall of the prepyloric gastric region was the commonest perforation site (80%). Eight patients (53.4%) had a course of H. pylori eradication therapy. The average hospital stay was 10.6 ± 6.3 days (4–32). Fourteen patients (93.3%) had an uneventful postoperative period, one developed nephrotic range proteinuria. All recovered fully.ConclusionsGastroduodenal PPU should be suspected in adolescent boys with a sudden onset of severe abdominal pain, positive peritoneal signs, and confirmed by pneumoperitoneum in the plain X-ray. Simple closure and eradication of H. pylori (when infection confirmed) are mandatory for a complete recovery.
Highlights
Peptic ulcer disease (PUD) is a known cause of paediatric abdominal pain, it is still an uncommon or at least not prevalent disorder among children in Western countries [1,2,3,4,5]
From 1994 to 2012, fifteen paediatric patients were treated for perforated peptic ulcer
Eleven patients (73.3%) had dyspepsia before PPU, 4 of them had a history of peptic ulcer disease
Summary
Peptic ulcer disease (PUD) is a known cause of paediatric abdominal pain, it is still an uncommon or at least not prevalent disorder among children in Western countries [1,2,3,4,5]. More than half of cases of PUD are diagnosed predominantly when complicated. In adults PUD is one of the commonest gastrointestinal disorders. The vast majority of reported PPU cases involve adults as well. The annual incidence of perforated gastric or duodenal ulcer in adults ranges from 3.8 to 14.0 per 100,000 inhabitants [6]. Paediatric PPU is a rare entity, in females, with a questionable and varying incidence in different geographical regions. We report our experience with PPU in children treated successfully
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