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

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.