Perforated peptic ulcer in children

Abstract

Introduction. The peptic ulcer disease (PUD) is an uncommon condition in paediatric surgical practice, more than half of cases are diagnosed predominantly when complicated. However, complications of PUD, particularly the perforation of the gastric or duodenal ulcer, are life threatening surgical emergency in this age group. Aim: The aim of our study was to analyse the clinical features, diagnosis and management of perforated peptic ulcer (PPU) in children. Materials and methods. The data of children diagnosed with PPU at Institute of Emergency Medicine, Moldova 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 the chi2, Student t test, and multivariate logistic regression for possible risk factors. Results. There were 18 boys aged 15 to 17 years (mean age 16.5 years ± 0,17 (95% CI: 16,15- 16,85)) included in the study. Fifteen patients (83.33%) were admitted in the first six hours after their abdominal pain started. Five patients had coexisting clinical events before PPU. All of the patients manifested acute abdominal pain. Physical examination revealed positive peritoneal signs in thirteen patients (72.22%). Radiography showed subdiaphragmatic free air in 8 patients (44.44%); this was the most important tool for establishing diagnosis. Thirteen patients (72.22%) underwent laparotomy (30.76% of them were covered with an omental patch, 61.53% were repaired with Judd, 1 patient with resection) and 5 were surgically treated with laparoscopic simple suture of the perforation and placement of an omental patch. Three patients (16.66%) had postoperative complications. The average hospital stay was 7,56± 0,39 (95% CI: 6,73- 8,37 days (range, 4-11 days). There were no mortalities. All recovered fully. Conclusions. Gastroduodenal perforated ulcer in pediatric age group is an uncommon entity; hence, it is not usually considered in the differential diagnosis of acute abdomen in these patients. PPU should be suspected in adolescents who manifest acute abdominal pain and have peritoneal signs. Laparoscopic repair is safe and should be the gold standard for treatment of perforated peptic ulcer in children.