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Vidović S, Borović S, Bašković M, Markić J, Pogorelić Z. Perforated peptic ulcers in children: a systematic review. BMC Pediatr 2025; 25:363. [PMID: 40335985 PMCID: PMC12057288 DOI: 10.1186/s12887-025-05725-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2025] [Accepted: 04/29/2025] [Indexed: 05/09/2025] Open
Abstract
BACKGROUND Perforated peptic ulcers (PPU) represent a significant complication of peptic ulcers, associated with high mortality. As no systematic review of the literature on PPU in children currently exists, this study aims to summarize findings from studies focusing on its risk factors, etiology, treatment modalities, and outcomes. METHODS A systematic review was conducted following the PRISMA guidelines. A literature search was performed on 24 November 2024, using four electronic databases: Web of Science, Scopus, PubMed, and ScienceDirect. The inclusion criteria were studies published in English, focusing on perforated peptic ulcers in paediatric patients. The exclusion criteria were: studies published in languages other than English; publication formats such as conference abstracts, personal communications, and single case reports; studies focusing on non-perforated peptic ulcers; studies involving participants > 18 years; and studies reporting ulcer perforations outside the stomach or duodenum. RESULTS Out of 1963 records identified, 12 studies met the inclusion criteria and were included in the review. A total of 239 children with perforated peptic ulcers were analyzed, with a median age of 11 years (range 3.2-16.5 years). The results indicate that ulcer perforations were more prevalent in males (74.8%). Furthermore, duodenal perforations (73%) were more common than gastric perforations (27%). The most commonly reported symptoms were abdominal pain (n = 175, 73.2%), vomiting (n = 82, 34.3%), peritoneal signs (n = 79, 33%), and fever (n = 38, 15.9%). Subdiaphragmatic free air was detected in 141 patients (58.9%). Of the total number of patients, 207 (86.6%) were treated surgically, while 32 (13.4%) received conservative treatment. Regarding the surgical approach, most patients underwent open surgery (n = 143, 69%) compared to laparoscopic repair (n = 64, 31%). Among the surgical procedures, 114 involved simple sutures, with or without an omental patch. Postoperative complications were reported in 30 children (14.5%). Reoperation was required in 4 patients (1.9%), and mortality was recorded in 9 patients (3.8%). CONCLUSIONS PPU was more prevalent in males and predominantly located in the duodenum. Ulcer suturing, with or without an omental patch, was the most commonly utilized treatment modality, demonstrating a relatively low complication rate. Further studies are needed to provide more comprehensive and unbiased evidence on PPU in children.
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Affiliation(s)
- Stipe Vidović
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, 31 000, Croatia
| | - Sara Borović
- School of Medicine, University of Split, Split, 21 000, Croatia
| | - Marko Bašković
- Department of Pediatric Surgery, Children's Hospital Zagreb, Zagreb, 10000, Croatia
- School of Medicine, University of Zagreb, Zagreb, 10000, Croatia
| | - Joško Markić
- School of Medicine, University of Split, Split, 21 000, Croatia
- Department of Pediatrics, University Hospital of Split, Split, 21 000, Croatia
| | - Zenon Pogorelić
- School of Medicine, University of Split, Split, 21 000, Croatia.
- Department of Pediatric Surgery, University Hospital of Split, Spinčićeva ulica 1, Split, 21 000, Croatia.
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Getu AM, Getahun AM, Ayen AA, Bekahegne MA, Awedew AF. Giant duodenal perforation: A rare malaria complication in a child; a case report and review of literature. Int J Surg Case Rep 2025; 126:110755. [PMID: 39700590 PMCID: PMC11718278 DOI: 10.1016/j.ijscr.2024.110755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2024] [Revised: 12/12/2024] [Accepted: 12/15/2024] [Indexed: 12/21/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Duodenal perforation, while uncommon, is a serious cause of acute abdomen in children. The causes of acute abdomen in children vary widely based on factors like geography and socioeconomic status. In developing countries, where infectious diseases are more prevalent, malaria can contribute to this condition. CASE PRESENTATION A 4-year-old boy from a malaria-endemic area presented with fever, vomiting, and prostration. Investigations revealed Plasmodium falciparum malaria. After initiating antimalarial treatment, he developed acute abdominal pain and was found to have a duodenal perforation. Emergency surgery was performed, and the perforation was repaired. CLINICAL DISCUSSION Duodenal perforation in children, though rare, is a potentially life-threatening complication that can occur in the context of severe malaria. Prompt surgical management, typically involving omental patch repair of the perforation and treatment of the underlying malaria infection, is crucial for successful outcomes. CONCLUSION Duodenal perforation in children following sever malaria attack is the rare which need urgent surgical and medical management.
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Affiliation(s)
- Abraham Molla Getu
- Department of Surgery, Debre Tabor Comprehensive Specialized Hospital, Debre Tabor, Ethiopia
| | | | - Addisu Assfaw Ayen
- Department of Internal Medicine, Debre Tabor University, Debre Tabor, Ethiopia
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Takamoto N, Konishi T, Fujiogi M, Kutsukake M, Morita K, Hashimoto Y, Matsui H, Fushimi K, Yasunaga H, Fujishiro J. Clinical course and management of pediatric gastroduodenal perforation beyond neonatal period. Pediatr Neonatol 2024:S1875-9572(24)00206-7. [PMID: 39709268 DOI: 10.1016/j.pedneo.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 05/20/2024] [Accepted: 06/18/2024] [Indexed: 12/23/2024] Open
Abstract
BACKGROUND The treatments and outcomes of pediatric gastroduodenal perforations have rarely been described. METHODS We retrospectively identified 515 patients aged 28 days to 17 years who were hospitalized for gastroduodenal perforation between July 2010 and March 2021 using a nationwide inpatient database. We compared characteristics, treatments, and outcomes for pediatric gastroduodenal perforation between children aged <7 years (n = 38) and ≥7 years (n = 477). RESULTS Children aged <7 years had a higher prevalence of females, comorbidities, and gastric perforation than those aged ≥7 years. Compared to children aged ≥7 years, children aged <7 years were more likely to receive surgical treatment (79% vs. 55%), open surgery (58% vs. 19%), and supportive treatment such as mechanical ventilation (39% vs. 2.5%), treatment for disseminated intravascular coagulation (13% vs. 1.3%), catecholamines (32% vs. 2.7%), blood transfusion (37% vs. 2.1%), and intensive care unit admission (47% vs. 7.1%). Children aged <7 years had higher in-hospital mortality (5.3% vs. 0.4%) and morbidity (18% vs. 4.8%) than those aged ≥7 years. CONCLUSIONS In pediatric gastroduodenal perforation, children aged <7 years were more likely to have comorbidities, undergo surgical and supportive treatments, and demonstrate poor outcomes than those aged ≥7 years.
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Affiliation(s)
- Naohiro Takamoto
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Takaaki Konishi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Michimasa Fujiogi
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan; Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Japan
| | - Mai Kutsukake
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Kaori Morita
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | | | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan
| | - Jun Fujishiro
- Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Japan.
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Ueda T, Sato H, Ogimi T, Deguchi R, Suzuki H. Use of Endoscopy to Remove Fish Bone That Caused Sigmoid Colon Perforation. Intern Med 2024; 63:2626-2630. [PMID: 38369354 PMCID: PMC11518597 DOI: 10.2169/internalmedicine.3063-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/10/2023] [Indexed: 02/20/2024] Open
Abstract
An 87-year-old man experiencing lower abdominal discomfort resulting from the ingestion of a fish bone underwent conservative management involving endoscopic extraction of the fish bone lodged in the sigmoid colon. Most patients with lower gastrointestinal tract perforations typically develop peritonitis or abscesses, necessitating surgical intervention. Notably, endoscopic management of lower gastrointestinal tract perforations is infrequently employed. Patients presenting with localized abdominal symptoms along with a stable overall health condition may benefit from conservative therapeutic approaches that utilize endoscopic methods. Notably, the transition from endoscopic procedures for foreign body removal to surgical intervention requires close collaboration with a surgeon and must be executed judiciously.
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Affiliation(s)
- Takashi Ueda
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Hirohiko Sato
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Takashi Ogimi
- Department of Gastroenterological Surgery, Tokai University School of Medicine, Japan
| | - Ryuzo Deguchi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Japan
| | - Hidekazu Suzuki
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Tokai University School of Medicine, Japan
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Teh D, Lukies M. Perforated duodenal ulcer in children: does preoperative CT add value? ANZ J Surg 2023; 93:3025-3027. [PMID: 37743576 DOI: 10.1111/ans.18700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/08/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Daniel Teh
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
| | - Matthew Lukies
- Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore, Singapore
- Department of Radiology, Alfred Health, Victoria, Melbourne, Australia
- Monash University, Monash University, Melbourne, Australia
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Giroux P, Palmer A, Thomas A, Camacho-Gomez SM. Helicobacter pylori Found Guilty of Obstructive Jaundice: A Pediatric Case Report. JPGN REPORTS 2023; 4:e348. [PMID: 38034451 PMCID: PMC10684119 DOI: 10.1097/pg9.0000000000000348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 06/15/2023] [Indexed: 12/02/2023]
Abstract
Pediatric Helicobacter pylori infection represents a small proportion of disease that is otherwise decreasing in the developed world. Typical presentations have been well-described in the literature. We report a 15-year-old male who presented with jaundice, anemia, dark urine, and poorly characterized abdominal pain and was found to have obstructive jaundice secondary to a duodenal ulcer resulting from H. pylori infection. Obstructive jaundice is a seldom reported complication of duodenal ulcer, particularly in children. This report reviews H. pylori infection, outlines complications of peptic ulcer disease, and illustrates the rarity of obstructive jaundice as a presenting sign of duodenal ulcer in children.
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Affiliation(s)
- Parker Giroux
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's of Mississippi, University of Mississippi Medical Center, Jackson, MS
| | - Andrew Palmer
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS
| | - Aby Thomas
- Department of Radiology, University of Mississippi Medical Center, Jackson, MS
| | - Sandra Mabel Camacho-Gomez
- From the Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's of Mississippi, University of Mississippi Medical Center, Jackson, MS
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Wang M, Sun S, Niu Q, Hu B, Zhao H, Geng L, Fu T, Qin H, Zheng B, Li H. Experience of management of pediatric upper gastrointestinal perforations: a series of 30 cases. Front Pediatr 2023; 11:1261336. [PMID: 37886238 PMCID: PMC10598647 DOI: 10.3389/fped.2023.1261336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/22/2023] [Indexed: 10/28/2023] Open
Abstract
Background This study aimed to explore the characteristics of pediatric upper gastrointestinal (UGI) perforations, focusing on their diagnosis and management. Methods Between January 2013 and December 2021, 30 children with confirmed UGI perforations were enrolled, and their clinical data were analyzed. Two groups were compared according to management options, including open surgical repair (OSR) and laparoscopic/gastroscopic repair (LR). Results A total of 30 patients with a median age of 36.0 months (1 day-17 years) were included in the study. There were 19 and 11 patients in the LR and OSR groups, respectively. In the LR group, two patients were treated via exploratory laparoscopy and OSR, and the other patients were managed via gastroscopic repair. Ten and three patients presented the duration from symptom onset to diagnosis within 24 h (p = 0.177) and the number of patients with hemodynamically unstable perforations was 4 and 3 in the LR and OSR groups, respectively. Simple suture or clip closure was performed in 27 patients, and laparoscopically pedicled omental patch repair was performed in two patients. There was no significant difference in operative time and length of hospital stay between the LR and OSR groups. Treatment failed in two patients because of severe sepsis and multiple organ dysfunction syndrome, including one with fungal peritonitis. Conclusion Surgery for pediatric UGI perforations should be selected according to the general status of the patient, age of the patient, duration from symptom onset, inflammation, and perforation site and size. Antibiotic administration and surgical closure remain the main strategies for pediatric UGI perforations.
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Affiliation(s)
- Mengqi Wang
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Shuai Sun
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Qiong Niu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Baoguang Hu
- Department of Gastrointestinal Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Haiyan Zhao
- Department of Colorectal Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Hong Qin
- Department of General Surgery, Children’s Hospital Affiliated to Shandong University, Jinan, China
| | - Bufeng Zheng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Hesheng Li
- Department of Gastrointestinal Surgery, Binzhou Medical University Hospital, Binzhou, China
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Role of Radiology and Laparoscopy in Childhood Peptic Ulcer Perforation. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2022; 2022:1211499. [PMID: 35910757 PMCID: PMC9328947 DOI: 10.1155/2022/1211499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/29/2022] [Accepted: 07/05/2022] [Indexed: 11/17/2022]
Abstract
Objective Peptic ulcer disease (PUD) in children is an uncommon disorder. An estimated 1.3 percent to 20 percent of people die from perforated peptic ulcers (PPU), a PUD consequence. Using a database, we assess the prevalence and prognosis of PPU in patients. We also do radiological and laparoscopic operations for PPU in young patients. In pediatric patients, sufficient accumulation of knowledge about laparoscopic repair is at the level of case reports. This study aims to assess the results in pediatric cases operated for PUP by open or laparoscopic surgery and determine the role of computed tomography (CT) in diagnosing PUP. Methods Data was collected from the Department of Pediatric Surgery, Sisli Hamidiye Etfal Training and Research Hospital, Turkey, from 2015 to 2020. Patients under 18 years of age who were operated on for PUP between 2015 and 2020 were divided into two groups. Group 1 involved those patients operated by laparoscopic surgery, whereas Group 2 involved those used by open surgery. Both groups were retrospectively evaluated in terms of demographic data, clinical findings, preoperative-intraoperative findings and surgical methods (open or laparoscopic), duration of surgery, duration of nasogastric intubation, time of return to oral feeding, length of hospital stay, and postoperative complications. Results 18 patients consisting of 15 boys and 3 girls were included in the study. Group 1 involved 10 patients, whereas Group 2 involved 8 patients. In Group 1, the symptom onset period was 1.6 ± 1.9 days, and in Group 2, it was 6.6 ± 6.1 days. In the erect abdominal radiographs (AXR) of 10 (58.8%) patients, the air was under the diaphragm. Six patients whose erect AXRs showed no attitude under the diaphragm but had abdominal pain and acute abdominal manifestation were given abdominal computed tomography (CT) scanning. In all patients with PUP, laparoscopic/open surgery involves primary suturing and repair by omentoplasty (Graham patch). The mean operative time was 87.0 ± 26.3 minutes in Group 1 and 122.5 ± 57.6 minutes in Group 2. The mean length of hospital stay was 3.9 ± 1.3 days in Group 1 and 5.8 ± 2.1 days in Group 2. Neither group developed any major surgical complications. Conclusions Adolescents with a history of sudden onset and severe abdominal pain may present with peptic ulcer perforation even if there is no known diagnosis of peptic ulcer or predisposing factor. In cases suspected of PUP, it is vital to order and carefully examine erect AXR, which is an easy and inexpensive method. Computed tomography should be the first choice in patients without free air in ADBG but whose anamnesis and findings match peptic ulcer perforation.
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Romero-Espitia W, Moreno-Villamizar D, Pedraza-Ciro M, Marín-Martínez S, Cabrera Vargas LF. Tratamiento laparoscópico de úlcera duodenal perforada mediante parche de Graham en un paciente pediátrico. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. La úlcera duodenal perforada es una entidad de etiología no clara que rara vez ocurre en la población pediátrica. Generalmente se diagnostica de manera intraoperatoria y el tratamiento ideal incluye el uso del parche de epiplón o de ser necesario, la resección quirúrgica.
Caso clínico. Se presenta un paciente de 12 años con abdomen agudo y diagnóstico tomográfico prequirúrgico de úlcera duodenal perforada, tratado por vía laparoscópica con drenaje de peritonitis y parche de Graham. La evolución y el seguimiento posterior fueron adecuados.
Discusión. La úlcera duodenal perforada es una entidad multifactorial, en la que se ha implicado el Helicobacter pylori. El diagnóstico preoperatorio es un reto y el tratamiento debe ser quirúrgico.
Conclusiones. Cuando se logra establecer el diagnóstico preoperatorio, se puede realizar un abordaje laparoscópico y el uso del parche de Graham cuando las úlceras son menores de dos centímetros.
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Zahra A, Ragab A, Al-Abboh H, Ismaiel A, Adekile AD. Perforated Duodenal Ulcer Associated with Deferasirox in a Child with β-Thalassemia Major. Hemoglobin 2022; 45:335-337. [PMID: 34979847 DOI: 10.1080/03630269.2021.2021937] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The oral iron chelator, deferasirox (DFX), is commonly associated with mild gastrointestinal (GI) complaints, but GI hemorrhage and ulcers have occasionally been reported. However, perforated duodenal ulcer (PDU) has been previously reported in only one patient with β-thalassemia major (β-TM) on Exjade (DFXE). We hereby report the second case of a 5-year-old Syrian patient, who recently presented with PDU while on DFXE. She was not on any other ulcerogenic medication and was negative for H. pylori and Celiac disease. She had a surgical repair and has done well. She is back on DFX, but with the film-coated tablet, Jadenu or DFXJ. Perforated duodenal ulcer should be suspected in patients with severe GI symptoms, abdominal distension and tenderness while on DFXE, especially at high doses (30+ mg/kg).
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Affiliation(s)
- Akmal Zahra
- Pediatric Hematology Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Abdullah Ragab
- Department of Pediatric Surgery, Ibn Sina, Sabah, Kuwait
| | - Hanan Al-Abboh
- Pediatric Hematology Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Ali Ismaiel
- Department of Pediatric Surgery, Ibn Sina, Sabah, Kuwait
| | - Adekunle D Adekile
- Pediatric Hematology Unit, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait.,Department of Pediatrics, Faculty of Medicine, Kuwait University, Jabriya, Kuwait
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Abdullateef KS, Azzam A, Gabr AA, Aboalazayem A, Elmenawi KA, Alshaer O, Marey M, Kaddah S, Gad MA. Laparoscopic repair with an omental patch for a perforated duodenal ulcer in children. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.102081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Perforated Duodenal Ulcer in a Young Nepalese Girl: An Infrequent Diagnosis for Age. Case Rep Pediatr 2021; 2021:6304309. [PMID: 34840845 PMCID: PMC8616671 DOI: 10.1155/2021/6304309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/10/2021] [Indexed: 11/18/2022] Open
Abstract
Perforated duodenal ulcer (PDU) is exceedingly uncommon in children. In a child with acute abdomen and pneumoperitoneum, an appendiceal etiology is more often suspected as a likely cause. Failure or delay to diagnose a PDU can result in significant morbidity and even mortality. We report a case of acute abdomen in a girl with PDU with a successful outcome. A 12-year-old school girl presented to emergency room (ER) with acute generalized abdominal pain for 2 days. Clinical examination revealed florid peritonitis, and abdominal radiographs showed free peritoneal air. At emergency laparotomy, PDU was noted with general peritoneal contamination. Omental patch repair and continued supportive care resulted in gradual improvement. PDU is an uncommon cause of peritonitis in children and poses significant challenges in management. Strong suspicion and prompt appropriate intervention is necessary to avoid untoward outcomes.
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Rifaii A, Osta A, Akel S, Assy J, El Rassi I. Perforated duodenum with hemorrhage while on V-V ECMO: Diagnostic challenge. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2021.101951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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It's not always appendicitis: relatively uncommon conditions of acute abdomen in children. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.863986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Aissam A. Spontaneous duodenal perforation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021. [DOI: 10.1016/j.epsc.2020.101740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Hattingh G, Salas-Parra RD, Nuzhad A, Salvador J, Farkas DT. Duodenal perforation in the pediatric population: two rare cases at a small community hospital. J Surg Case Rep 2020; 2020:rjaa455. [PMID: 33294157 PMCID: PMC7700762 DOI: 10.1093/jscr/rjaa455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/19/2020] [Accepted: 10/13/2020] [Indexed: 01/01/2023] Open
Abstract
Duodenal ulcer perforation is very uncommon in the pediatric population; hence, it is usually not considered in the differential diagnosis of acute abdomen in this age group. In our small community hospital, we had two rare cases of perforated peptic ulcer in the pediatric population within a short span of time. A 14-year-old male and a 13-year-old female child presented to the emergency room with acute abdominal pain. No other symptoms were reported and neither had any history of peptic ulcer disease. Abdominal CT showed pneumoperitoneum consistent with perforated hollow viscus. Subsequent exploratory laparotomy indicated perforated duodenal ulcer in both children. These cases illustrate that perforated peptic ulcers should be considered in children presenting with acute abdomen.
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Affiliation(s)
| | | | - Afrin Nuzhad
- St. George’s University School of Medicine, St. George, Grenada
| | - Joselyn Salvador
- Department of Pediatrics, Bronxcare Health System, Bronx, NY 10457, United States
| | - Daniel T Farkas
- Department of Surgery, Bronxcare Health System, Bronx, NY, USA
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Perforated gastric ulcer following perforated appendicitis. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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The pediatric stomach - masses and mass-like pathology. Pediatr Radiol 2020; 50:1180-1190. [PMID: 32474774 DOI: 10.1007/s00247-020-04697-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 03/22/2020] [Accepted: 04/23/2020] [Indexed: 02/06/2023]
Abstract
Diagnostic imaging of pediatric gastric masses often provides a challenge for the practicing radiologist. Radiologists should be aware of this relatively unusual pathology, particularly in cross-sectional imaging findings. We will review pediatric gastric masses and mass-like lesions, focusing on neoplastic and inflammatory etiologies.
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Ammor A, Nasri S, Rkain M, Benhaddou H. Perforated gastric ulcer: An unusual cause of peritonitis in children. Afr J Paediatr Surg 2020; 17:115-118. [PMID: 33342847 PMCID: PMC8051632 DOI: 10.4103/ajps.ajps_18_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Perforated gastric ulcer is a particularly rare cause of peritonitis in children. Only few cases have been reported in the literature. It is a serious emergency condition which can be overlooked leading to life-threatening consequences. We report a case of a 12-year-old girl who presented with acute abdominal pain and signs of peritonitis. Surgical exploration found a gastric perforation on the anterior side of the antrum. Primary repair of the perforation was performed after thorough decontamination and taking biopsies from its edges. The post-operative period was uneventful. Helicobacter pylori test was negative. Histopathology result was suggestive of ulceration in the gastric wall and did not isolate H. pylori. Gastro-duodenal ulcer perforation should be considered in the differential diagnosis of children presenting with acute abdomen, especially when imaging showing pneumoperitoneum.
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Affiliation(s)
- Abdelouhab Ammor
- Department of Visceral and Urological Pediatric Surgery, University Hospital Center of Oujda, Oujda, Morocco
| | - Siham Nasri
- Radiology, University Hospital Center of Oujda, Oujda, Morocco
| | - Maria Rkain
- Pediatrics, University Hospital Center of Oujda, Oujda, Morocco
| | - Houssain Benhaddou
- Department of Visceral and Urological Pediatric Surgery, University Hospital Center of Oujda, Oujda, Morocco
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Pediatric gastric perforation beyond neonatal period: 8-year experience with 20 patients. Pediatr Neonatol 2019; 60:634-640. [PMID: 30992193 DOI: 10.1016/j.pedneo.2019.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 03/08/2019] [Accepted: 03/08/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND To describe the characteristics, treatments, and prognosis of pediatric gastric perforation patients beyond neonatal period. METHODS Twenty pediatric patients beyond neonatal period were included in this study. Medical records were reviewed and clinical characteristics were analyzed. According to the outcomes, patients were divided into the survival group and the death group. Death time was documented, and survival patients were followed up. The degree of severity was calculated using pediatric critical illness score (PCIS). Differences between the two groups were analyzed by the Student's t-test, Mann-Whitney test and Chi-square test appropriately. RESULTS Gastric perforation was diagnosed in 20 pediatric patients beyond neonatal period, including 6 males (30%) and 14 females (70%), with the age of 37.18 (15.90, 107.12) months, and the range was from 4.30 months to 14.17 years old. They had different manifestations, etiologies, sites of perforation and surgery procedures. Among the 20 cases, 14 (70%) survived and 6 (30%) died. Age, gender, length and number of perforation had no statistically difference between the two groups. However, PCIS, ischemia of gastrointestinal wall, and transmural necrosis of gastric wall were statistically different. For the survival group, during a follow-up period of 50 (36, 68) months, ranging from 2 months to 8 years and 7 months, one patient had a second-time perforation, another 3 patients had brain injury symptoms, and the rest 10 patients had good quality of lives. CONCLUSIONS Gastric perforation of pediatric patients beyond neonatal period causes a mortality of 30% on this study. Spontaneous great curvature of gastric wall perforation has the highest morbidity. Low PCIS predicts for unfavorable prognosis. Most of the survival patients have satisfactory living quality after operation.
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Yan X, Kuang H, Zhu Z, Wang H, Yang J, Duan X, Bian H, Zheng N, Chen X. Gastroduodenal perforation in the pediatric population: a retrospective analysis of 20 cases. Pediatr Surg Int 2019; 35:473-477. [PMID: 30448888 DOI: 10.1007/s00383-018-4420-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the pathogenesis, symptoms and individualized surgical management in pediatrics with gastroduodenal perforation (GDP). METHODS Patients diagnosed with GDP from January 2013 to December 2016 in our hospital were collected and divided into gastric perforation (GP) group and duodenal perforation (DP) group. Demographics, clinical events, etiological factors, symptoms, the time from symptom onset to operation, intraoperative findings and surgical procedures were analyzed. Follow-ups including ulcer, perforations occurrence, and digestive symptoms were carried out by out-patient review or telephones. RESULTS A total of 20 patients aged from 3 months to 14 years were enrolled in this study. The average age, main clinical presentations, size of perforations and operating time between two groups had no difference. The male to female ratio in DP group was higher than GP (P < 0.05). The high risk factor for DP was the use of dexamethasone, and for GP was HP infection. The most common site of perforation in DP group was duodenal bulb, and in GP group was pylorus area. Simple suture is the main management for both DP and GP, but distal gastrectomy combined with gastrojejunal Roux-en-Y anastomosis may be an alternative procedure for large perforation with diameter > 2 cm. The length of hospital days in GP group is shorter than DP group (P < 0.05). For follow-up, no patients had digestive symptoms. CONCLUSIONS The general condition had no difference between GP and DP patients. But the risk factors and surgical repair differ depending on the patient's fundamental illness and the complexity of the perforation.
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Affiliation(s)
- Xueqiang Yan
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Houfang Kuang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Zhenchuang Zhu
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Haibin Wang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Jun Yang
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Xufei Duan
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Hongqiang Bian
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Nannan Zheng
- Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Xuyong Chen
- The Research Institute at Nationwide Children's Hospital, The Ohio State University School of Medicine, 700 Children's Drive, Columbus, OH, 43205, USA.
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Munoz Abraham AS, Osei H, Martino A, Kazmi S, Saxena S, Fitzpatrick CM, Villalona GA. Incidence and Outcomes of Perforated Peptic Ulcers in Children: Analysis of the Kid's Inpatient Database and Report of Two Cases Treated by Laparoscopic Omental Patch Repair. J Laparoendosc Adv Surg Tech A 2019; 29:248-255. [DOI: 10.1089/lap.2018.0186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Affiliation(s)
- Armando Salim Munoz Abraham
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Hector Osei
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Alice Martino
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Sakina Kazmi
- Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Saurabh Saxena
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
| | - Colleen M. Fitzpatrick
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
| | - Gustavo A. Villalona
- Division of Pediatric Surgery, Department of Surgery, Saint Louis University School of Medicine, Saint Louis, Missouri
- Department of Pediatric Surgery, SSM Cardinal Glennon Children's Hospital, Saint Louis, Missouri
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Tang Z, Shi J, Ji M, Shi P, Huang Z, Huang Y. The characteristics of 83 giant peptic ulcers in Chinese children: Evaluation and follow-up. Saudi J Gastroenterol 2018; 24:360-364. [PMID: 30136703 PMCID: PMC6253915 DOI: 10.4103/sjg.sjg_147_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND/AIMS Giant peptic ulcers (GPUs) are detrimental for all patients, especially for children. However, few reports have described GPUs in children. This study aims to evaluate the characteristics of GPUs in Chinese children and to identify risk factors. PATIENTS AND METHODS We retrospectively analyzed patients at the Children's Hospital of Fudan University from April 2014 to August 2017. Patients with GPUs (>2.0 cm) were included in the study, and the clinical data, pathological characteristics and presence of Helicobacter pylori (H. pylori) infection were analyzed to evaluate the outcomes. RESULTS A total of 19208 children underwent gastroscopic examinations, and 83 patients with GPUs were enrolled. The mean age of onset for GPU patients was 9.7 ± 3.2 years(range, 1-15). The main complaints were abdominal pain (92.7%), anemia (53%), retching (45.8%), hematochezia (21.7%) and hematemesis (16.9%). With respect to the types of GPU, 68 patients (81.9%) had duodenal ulcers, and 15 patients (18.1%) had gastric ulcers. Compared to the group <6 years of age, the group ≥6 years was more susceptible to GPU (P < 0.05). Among GPU patients, 71.1% of cases were H. pylori (*) (59/83), and 16.9% (14/83) of patients were H. pylori (-). Compared to the H. pylori (-) group, the H. pylori (*) group showed inflammatory activity, atrophy and lymphoid follicular formation in the gastric mucosa (P < 0.05). CONCLUSIONS This study suggests that GPUs are strongly associated with H. pylori infection in Chinese children. Duodenal ulcers are the main type of GPU in patients older than 6 years. Appropriate diagnosis, treatment and follow-up are necessary for children with GPUs.
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Affiliation(s)
- Zifei Tang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Jieru Shi
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Min Ji
- Department of Radiology, Children's Hospital of Fudan University, Shanghai, China
| | - Peng Shi
- Department of Information, Children's Hospital of Fudan University, Shanghai, China
| | - Zhiheng Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
| | - Ying Huang
- Department of Gastroenterology, Children's Hospital of Fudan University, Shanghai, China
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Zárate-Suárez LA, Urquiza-Suárez YL, García CF, Padilla-Mantilla DA, Mendoza MC. Acute abdomen and perforated duodenal ulcer in an adolescent: case report. REVISTA DE LA FACULTAD DE MEDICINA 2018. [DOI: 10.15446/revfacmed.v66n2.59798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
El dolor abdominal agudo es uno de los principales motivos de consulta en los servicios de urgencias, sus causas son diversas y se dividen en quirúrgicas y médicas. En este artículo se hace mención a las causas quirúrgicas que pueden ser de tipo traumático, obstructivo o inflamatorio. En esta última categoría se encuentra la perforación de víscera hueca como complicación de ulcera duodenal, entidad poco frecuente en la edad pediátrica.Se presenta el caso de un adolescente de 14 años, previamente sano, quien consultó a urgencias de medicina general por dolor abdominal de inicio súbito y de rápido progreso en hipocondrio derecho, con irradiación a zona lumbar del mismo lado, asociado a síntomas vaso vágales. Se da manejo primario como urolitiasis.Ante el deterioro clínico y los signos evidentes de peritonitis generalizada, el paciente es llevado a laparoscopia diagnóstica que requiere conversión a laparotomía por cirugía pediátrica. El hallazgo quirúrgico es úlcera duodenal perforada como causa del cuadro clínico. Este reporte pretende mostrar la experiencia de los casos clínicos en los que se da un error diagnóstico inicial e incluir a la ulcera duodenal complicada como diagnóstico diferencial.
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Amouei A, Ehsani F, Zarch MB, Tabatabaei SM, Ghodratipour Z. Peritonitis Following Duodenal Ulcer Perforation in a Newborn: A Case Report. J Clin Diagn Res 2017; 10:PD10-PD11. [PMID: 28050434 DOI: 10.7860/jcdr/2016/22458.8821] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/17/2016] [Indexed: 11/24/2022]
Abstract
Duodenal ulcer is an uncommon condition in children, that is why it is not usually considered as the differential diagnosis unless it presents with complications including perforation and haemorrhage. Moreover, duodenal ulcer perforation is an uncommon entity in paediatric age group. Early diagnosis and treatment is crucial in order to improve survival. A three-day-old male neonate was admitted to our hospital because of abdominal distension. The neonate was lethargic. He underwent laparotomy. There was a perforated ulcer, 5×5mm in size, on the anterior aspect of the first part of the duodenum. The perforated ulcer was closed with a single layer. Six-month follow-up revealed no abnormality.
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Affiliation(s)
- Abdolhamid Amouei
- Assistant Professor, Department of Surgery, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences , Yazd, Iran
| | - Fatemeh Ehsani
- Resident, Department of Surgery, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences , Yazd, Iran
| | - Mojtaba Babaei Zarch
- Medical Student, School of Medicine, Shahid Sadoughi University of Medical Sciences , Yazd, Iran
| | - Seyed Mostafa Tabatabaei
- Resident, Department of Surgery, Shahid Sadoughi Hospital, Shahid Sadoughi University of Medical Sciences , Yazd, Iran
| | - Zahra Ghodratipour
- Medical Student, Department of General Practitioner, Shahid Sadoughi University of Medical Sciences , Yazd, Iran
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Ndoye NA, Konate I, Diouf C, Dieng M, Niang D, Ndour O, Ngom G, Fall I. Peritonitis by jejunal ulcer perforation in a child: a case report. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2016.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation). Case Rep Pediatr 2016; 2016:3092130. [PMID: 27843663 PMCID: PMC5097802 DOI: 10.1155/2016/3092130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 09/21/2016] [Accepted: 10/05/2016] [Indexed: 11/30/2022] Open
Abstract
Plasmodium falciparum, the commonest cause of severe malaria in children, is an important cause of mortality in developing nations like Nepal. Duodenal perforation in a case of complicated malaria, although a rare entity, can occur in children. Early diagnosis, proper medical treatment, and early surgical repair can be a lifesaving measure in such cases. Here, we report a case of a 5-year-old male child with falciparum malaria complicated by a duodenal perforation that was successively managed with appropriate antimalarial drugs and early surgical repair.
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Perforated Duodenal Ulcer. Pediatr Emerg Care 2016; 32:200-1. [PMID: 26928104 DOI: 10.1097/pec.0000000000000734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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30
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Ueda N. Gastroduodenal Perforation and Ulcer Associated With Rotavirus and Norovirus Infections in Japanese Children: A Case Report and Comprehensive Literature Review. Open Forum Infect Dis 2016; 3:ofw026. [PMID: 26989751 PMCID: PMC4794947 DOI: 10.1093/ofid/ofw026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 02/05/2016] [Indexed: 12/12/2022] Open
Abstract
Race, young age, male gender, severe dehydration, metabolic acidosis, drowsiness/unconsciousness and shock are associated with gastroduodenal perforation/ulcer (GDPU) in childhood rotaviruses and noroviruses gastroenteritis. Awareness of the risk of GDPU prevents lethal outcome in these common infections among young children. Background. There is no literature review on gastroduodenal perforation or ulcer (GDPU) with rotavirus (RV) and norovirus (NoV) gastroenteritis. Methods. Pediatric cases of GDPU or upper gastrointestinal bleeding with RV and NoV gastroenteritis were searched from September 1974 until October 2015 using PubMed, Google for English, other-language-publications, and Ichushi (http://www.jamas.or.jp) for Japanese-language publications. All reports confirming GDPU or upper gastrointestinal bleeding with RV and NoV gastroenteritis were eligible for inclusion in the study. In addition, clinical characteristics were reviewed. Results. A boy with duodenal ulcer (DU) and NoV gastroenteritis was described. There were 32 GDPU cases (23 RVs and 9 NoVs cases), including our case; with the exception of 1 case, all were Japanese. Mean age, male/female ratio, and symptoms' duration before admission were 21.6 months, 2.2, and 4.0 days, respectively. Vomiting was the most common symptom, followed by diarrhea, lethargy, fever, abdominal distension, and convulsion. Dehydration, hematemesis, melena, drowsiness or unconsciousness, shock, metabolic acidosis, leukocytosis, anemia, positive C-reactive protein, high blood urea nitrogen, and hyponatremia commonly occurred. Helicobacter pylori was a minor cause of GDPU. Duodenal (DP) or gastric perforation (GP) developed in 14 cases (10 DP/RVs, 1 GP/RV, and 3 DP/NoVs). Duodenal ulcer or gastric ulcer (GU) developed in 18 cases (10 DU/RVs, 4 DU/NoVs, 1 GU/RV, 1 GU + DU/NoV, and 2 upper gastrointestinal bleeding/RVs). The predominant perforation or ulcer site was in the duodenum. With the exception of 2 deaths from DU, all cases recovered. Conclusions. Race, young age, male, severe dehydration, metabolic acidosis, drowsiness and unconsciousness, and shock may be potential risk factors of GDPU associated with RV and NoV gastroenteritis. Limitation of this descriptive study warrants further investigations to determine the risk factors in these infections that could be associated with GDPU.
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Affiliation(s)
- Norishi Ueda
- Department of Pediatrics , Public Central Hospital of Matto Ishikawa , Hakusan , Japan
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Wong CWY, Chung PHY, Tam PKH, Wong KKY. Laparoscopic versus open operation for perforated peptic ulcer in pediatric patients: A 10-year experience. J Pediatr Surg 2015; 50:2038-40. [PMID: 26386878 DOI: 10.1016/j.jpedsurg.2015.08.025] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 08/24/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) is a relatively uncommon condition in children. We aim to evaluate and compare the outcomes of laparoscopic omental patch repair versus open repair for PPU in pediatric patients. METHODS Children who underwent omental patch repair for PPU from 2004 to 2014 in our hospital were reviewed retrospectively. Patient demographics, perioperative as well as intraoperative details and surgical outcomes, were analyzed. RESULTS Thirteen patients were identified, and all presented with abdominal pain. The median age of the study group was 14.9years (range 6.3 to 18.4years). Radiological evidence of pneumoperitoneum on erect chest x-ray (CXR) was found only in five patients (38.5%). None of the patients had a known history of peptic ulcer disease. Diagnosis other than PPU was made in five patients preoperatively. Laparoscopic repair was attempted in eight patients with one of them requiring conversion. There was no significant difference in patient demographics when compared with the open repair group. The perforation site was in the duodenum in 11 patients and in the antrum in two patients. The mean size of perforation was larger in the open repair group (p=0.005). Although the operating time was longer in the laparoscopic group (p=0.51), the length of hospital stay was significantly shorter (p=0.048). Only two patient diseases were Helicobacter pylori related. CONCLUSION Clinical features of perforated peptic ulcer in children are different from adults. Risk factors are less frequently identified. Laparoscopic omental patch repair is a feasible surgical option and is associated with satisfactory outcomes in pediatric practice.
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Affiliation(s)
- Carol W Y Wong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | - Patrick H Y Chung
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | - Paul K H Tam
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong
| | - Kenneth K Y Wong
- Department of Surgery, The University of Hong Kong, Queen Mary Hospital, Pokfulam Road, Hong Kong.
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Riggle KM, Wahbeh G, Williams EM, Riehle KJ. Perforated duodenal ulcer: An unusual manifestation of allergic eosinophilic gastroenteritis. World J Gastroenterol 2015; 21:12709-12712. [PMID: 26640348 PMCID: PMC4658626 DOI: 10.3748/wjg.v21.i44.12709] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/04/2015] [Accepted: 09/02/2015] [Indexed: 02/06/2023] Open
Abstract
Spontaneous perforation of a duodenal ulcer secondary to allergic eosinophilic gastroenteritis (EGE) has not been previously reported. We present such a case in a teenager who presented with peritonitis. After exploration and operative repair of his ulcer, he continued to experience intermittent abdominal pain, and further evaluation revealed eosinophilic gastroenteritis in the setting of multiple food allergies. His EGE resolved after adhering to a restrictive diet. Both duodenal ulcers and EGE are very rarely seen in pediatric patients. EGE has a variable presentation depending on the layer(s) of bowel wall affected and the segment of the gastrointestinal tract that is involved. Once diagnosed, it may respond to dietary changes in patients with recognized food allergies, or to steroids in patients in whom an underlying cause is not identified. Our case highlights the need to keep EGE in the differential diagnosis when treating pediatric patients with duodenal ulcers. The epidemiology, pathophysiology, and treatment of EGE are also discussed, along with a review of the current literature.
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Huang CC, Lai MW, Hwang FM, Yeh YC, Chen SY, Kong MS, Lai JY, Chen JC, Ming YC. Diverse presentations in pediatric Meckel's diverticulum: a review of 100 cases. Pediatr Neonatol 2014; 55:369-75. [PMID: 24685339 DOI: 10.1016/j.pedneo.2013.12.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/13/2013] [Accepted: 12/09/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Our objective was to analyze demographics and characteristics of Meckel's diverticulum with different manifestations in pediatric patients. METHODS This is a retrospective study in children with symptomatic Meckel's diverticulum who underwent resection between September 1998 and October 2010. The diagnosis was confirmed by surgery and pathology. Demographic characteristics, manifestations, Meckel's scan results, surgical and histological findings were analyzed. RESULTS One hundred symptomatic Meckel's diverticula were identified in 74 boys and 26 girls aged from one day to 18 years old over 13 years. Depending on whether or not obstruction occurred, the patients were classified into two categories. Each category was further subdivided into two diagnostic groups: 17 intussusception and 24 non-intussusception bowel obstruction in the obstructive category and 44 gastrointestinal bleeding and 15 diverticulitis and/or perforation in the non-obstructive category. The sex discrepancy was higher in the non-obstructive category than in the obstructive category (male-to-female, 4.36 vs. 1.73, p < 0.05). Forty-one of 44 patients with gastrointestinal bleeding underwent a Meckel's scan with a high positive rate (92.7%). The ectopic tissues were identified in 73 patients and included 61 gastric type, two pancreatic type and 10 mixed type. Ectopic tissues were more prevalent in non-obstructive category (p < 0.05) with ectopic gastric tissue even more pronounced (p < 0.01). Ectopic pancreatic tissue was significantly more prevalent in intussusception (p < 0.01). Laparoscopic surgery was performed more frequently in Meckel's diverticulum with non-obstructive symptoms (p < 0.001). CONCLUSION Diverse presentations in pediatric Meckel's diverticulum are affected by different ectopic tissue types and male sex. Laparoscopic surgery is widely used for children with non-obstructive symptoms.
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Affiliation(s)
- Chen-Chuan Huang
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Wei Lai
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Fang-Ming Hwang
- Department of Education, National Chiayi University, Chiayi, Taiwan
| | - Yu-Chen Yeh
- Institute of Education, National Chiao Tung University, Hsinchu, Taiwan
| | - Shih-Yen Chen
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Man-Shan Kong
- Division of Pediatric Gastroenterology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jin-Yao Lai
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Jeng-Chang Chen
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yung-Ching Ming
- Department of Pediatric Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Munro A, Tighe M. Puzzling peritonitis in an adolescent. Arch Dis Child 2014; 99:686. [PMID: 24709939 DOI: 10.1136/archdischild-2014-306247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Mbarushimana S, Morris-Stiff G, Thomas G. Atypical presentation of perforated peptic ulcer disease in a 12-year-old boy. BMJ Case Rep 2014; 2014:bcr-2014-204716. [PMID: 24973349 DOI: 10.1136/bcr-2014-204716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 12-year-old boy was referred to the surgical unit with 4 h history of severe lower abdominal pain and bilious vomiting. No other symptoms were reported and there was no significant medical or family history. Examination revealed tenderness in the lower abdomen, in particular the left iliac fossa. His white cell count was elevated at 19.6×10(9)/L, with a predominant neutrophilia of 15.8×10(9)/L and a C reactive protein of <0.3 mg/L. An abdominal X-ray revealed intraperitoneal gas and a chest X-ray identified free air under both hemidiaphragms. Subsequent diagnostic laparoscopy identified a perforated duodenal ulcer that was repaired by means of an omental patch. The case illustrates that although uncommon, alternate diagnoses must be borne in mind in children presenting with lower abdominal pain and diagnostic laparoscopy is a useful tool in children with visceral perforation as it avoids treatment delays and exposure to excess radiation.
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Affiliation(s)
| | | | - George Thomas
- Department of General Surgery, Western Trust, Enniskillen, UK
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Yildiz T, Ilce HT, Ceran C, Ilce Z. Simple patch closure for perforated peptic ulcer in children followed by helicobacter pylori eradication. Pak J Med Sci 2014; 30:493-6. [PMID: 24948965 PMCID: PMC4048492 DOI: 10.12669/pjms.303.4705] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 12/27/2013] [Accepted: 03/05/2014] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE Peptic ulcer disease in children is rare. Therefore, the diagnosis can be missed until complications such as perforation or hemorrhage occur. Few reports have investigated the procedures and outcomes of children who have undergone operations for perforated duodenal ulcers. We report our experience with the modified Graham technique for perforated duodenal ulcers in nine children and review the literature. Methods : The records of patients operated on for a perforated duodenal ulcer in the last 8 years in two pediatric surgery centers were evaluated retrospectively. Patient demographics, symptoms, time to admission to hospital, operative findings, and postoperative clinical course were evaluated. Results : Nine children (mean age 13.2 years, range 6-170 years) were included. All patients were admitted in the first six hours after their abdominal pain started. In three patients, there was free air on plain x-rays, while the x-rays were normal in six. All perforations were located on the anterior surface of the first part of the duodenum and repaired with primary suturing and Graham patch omentoplasty. The recovery was uneventful in all patients. In five patients, urea breath tests were performed postoperatively for Helicobacter Pylori, and the results were positive. All patients underwent triple therapy with lansoprazole, amoxicillin, and clarithromycin. The mean follow-up time was 58 (range 3-94) months. Conclusions : Peptic ulcer perforation should be suspected in children who have acute abdominal pain and peritoneal signs, especially when their suffering is intense. The simple patch repair and postoperative triple therapy for Helicobacter Pylori are safe and satisfactory for treating peptic ulcer perforation in children.
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Affiliation(s)
- Turan Yildiz
- Turan Yildiz, Department of Pediatric Surgery, Sakarya University Medical Schools, Sakarya, Turkey
| | - Huri Tilla Ilce
- Huri Tilla Ilce, Department of Nucleer Medicine, Sakarya University Medical Schools, Sakarya, Turkey
| | - Canan Ceran
- Canan Ceran, Department of Pediatric Surgery,Inonu University Medical Schools, Malatya, Turkey
| | - Zekeriya Ilce
- Zekeriya Ilce,Department of Pediatric Surgery, Sakarya University Medical Schools, Sakarya, Turkey
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Clark ME, Osten AW, Abbas MI, Edwards MJ. Hepatic abscess following NSAID use in an adolescent. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2014. [DOI: 10.1016/j.epsc.2013.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Morrison S, Ngo P, Chiu B. Perforated peptic ulcer in the pediatric population: A case report and literature review. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Søreide K, Thorsen K, Søreide JA. Strategies to improve the outcome of emergency surgery for perforated peptic ulcer. Br J Surg 2013; 101:e51-64. [PMID: 24338777 DOI: 10.1002/bjs.9368] [Citation(s) in RCA: 123] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Perforated peptic ulcer (PPU) is a common surgical emergency that carries high mortality and morbidity rates. Globally, one-quarter of a million people die from peptic ulcer disease each year. Strategies to improve outcomes are needed. METHODS PubMed was searched for evidence related to the surgical treatment of patients with PPU. The clinical registries of trials were examined for other available or ongoing studies. Randomized clinical trials (RCTs), systematic reviews and meta-analyses were preferred. RESULTS Deaths from peptic ulcer disease eclipse those of several other common emergencies. The reported incidence of PPU is 3.8-14 per 100,000 and the mortality rate is 10-25 per cent. The possibility of non-operative management has been assessed in one small RCT of 83 patients, with success in 29 (73 per cent) of 40, and only in patients aged less than 70 years. Adherence to a perioperative sepsis protocol decreased mortality in a cohort study, with a relative risk (RR) reduction of 0.63 (95 per cent confidence interval (c.i.) 0.41 to 0.97). Based on meta-analysis of three RCTs (315 patients), laparoscopic and open surgery for PPU are equivalent, but patient selection remains a challenge. Eradication of Helicobacter pylori after surgical repair of PPI reduces both the short-term (RR 2.97, 95 per cent c.i. 1.06 to 8.29) and 1-year (RR 1.49, 1.10 to 2.03) risk of ulcer recurrence. CONCLUSION Mortality and morbidity from PPU can be reduced by adherence to perioperative strategies.
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Affiliation(s)
- K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, and Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Ndour O, Bansouda J, Fall A, Alumeti D, Diouf C, Ngom G, Ndoye M. Les péritonites par perforation d’ulcère gastroduodénal chez l’enfant : à propos de 4 observations. Arch Pediatr 2012; 19:1065-9. [DOI: 10.1016/j.arcped.2012.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 05/13/2012] [Accepted: 07/09/2012] [Indexed: 10/26/2022]
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Abstract
A perforated peptic ulcer in a child is a rare entity. Severe abdominal pain in an ill-appearing child with a rigid abdomen and possibly with signs of shock is the typical presenting feature of this life-threatening complication of peptic ulcer disease. We present a case of a 14.5-year-old adolescent girl who developed abdominal and shoulder pain that resolved after 1 day. She was then completely well for 2 days until the abdominal and shoulder pain recurred. On examination, she appeared well, but in pain. A chest radiograph revealed a large pneumoperitoneum. She underwent emergent laparoscopic omental patch repair of a perforated ulcer on the anterior wall of her stomach. Result of a urea breath test to detect Helicobacter pylori was negative. The differential diagnosis of pneumoperitoneum in children is discussed, as are childhood perforated peptic ulcer in general, and the unique clinical features present in this case in particular.
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Etiology and Treatment of Childhood Peptic Ulcer Disease in Taiwan: A Single Center 9-Year Experience. J Formos Med Assoc 2010; 109:75-81. [PMID: 20123589 DOI: 10.1016/s0929-6646(10)60024-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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