Duodenal ulcer perforation peritonitis as a cause of acute abdomen in pediatric population: a rare case report and review of literature.

IF 1.7 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Medicine and Surgery Pub Date : 2025-04-29 eCollection Date: 2025-06-01 DOI:10.1097/MS9.0000000000003315
K C Suraj, Tek Nath Yogi, Krish Rauniyar, Rajesh Prasad Sah, Amrit Bhusal, Rijan Kafle, Nakendra Malla, Manish Gahatraj
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Abstract

Introduction: Acute abdomen in pediatric patients presents diagnostic challenges due to the wide range of potential causes and overlapping clinical features. Duodenal ulcer perforation, though rare, can mimic more common conditions like appendicitis, complicating diagnosis and management. Perforated peptic ulcer disease (PUD) in children, especially without chronic nonsteroidal anti-inflammatory drug (NSAID) use or Helicobacter pylori infection, is uncommon but requires prompt recognition.

Case presentation: A 9-year-old male presented with severe diffuse abdominal pain, fever, and a history of chills. Physical examination revealed tenderness, board-like rigidity, and sluggish bowel sounds. Laboratory tests showed leukocytosis, but radiological findings, including abdominal X-ray, were normal. Ultrasound indicated gaseous abdomen and fluid collection. An exploratory laparotomy revealed a perforation in the first part of the duodenum, which was repaired using a Graham omental patch. Postoperatively, the patient recovered well with intravenous antibiotics and was discharged on the sixth postoperative day.

Clinical discussion: Duodenal ulcer perforation, though rare, should be considered in pediatric cases of acute abdomen. Common causes of PUD include H. pylori infection, NSAIDs, and stress-related ulcers. Diagnosis is often delayed, particularly when typical radiological signs like pneumoperitoneum are absent, as in this case. Timely surgical intervention is critical to prevent morbidity and mortality.

Conclusion: Duodenal ulcer perforation should be considered as a potential cause of peritonitis in children with acute abdomen, even in the absence of typical radiographic signs. Early recognition and surgical intervention are essential for favorable outcomes.

十二指肠溃疡穿孔性腹膜炎致小儿急腹症1例罕见病例报告及文献复习。
简介:急腹症在儿科患者提出诊断挑战,由于广泛的潜在原因和重叠的临床特征。十二指肠溃疡穿孔虽然罕见,但可以模仿阑尾炎等更常见的疾病,使诊断和治疗复杂化。儿童穿孔性消化性溃疡(PUD),尤其是未使用慢性非甾体抗炎药(NSAID)或幽门螺杆菌感染的儿童,并不常见,但需要及时识别。病例介绍:一名9岁男性,表现为严重弥漫性腹痛、发热和发冷史。体格检查显示有压痛,板状僵硬,肠音迟缓。实验室检查显示白细胞增多,但放射检查,包括腹部x线检查,正常。超声显示腹部有气体和积液剖腹探查发现十二指肠第一部分穿孔,使用Graham网膜补片修复。术后患者静脉注射抗生素恢复良好,于术后第6天出院。临床讨论:十二指肠溃疡穿孔虽然罕见,但在小儿急腹症病例中应予以考虑。PUD的常见病因包括幽门螺杆菌感染、非甾体抗炎药和压力相关溃疡。诊断常常延迟,特别是当没有气腹等典型放射学征象时,如本例。及时的手术干预是预防发病率和死亡率的关键。结论:即使没有典型的影像学征象,十二指肠溃疡穿孔也应被认为是小儿急腹症腹膜炎的潜在病因。早期识别和手术干预对于获得良好的预后至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Annals of Medicine and Surgery
Annals of Medicine and Surgery MEDICINE, GENERAL & INTERNAL-
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