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Perforated duodenal ulcer presenting with massive hematochezia in a 30-month-old child
Na Mi Lee1, Sin Weon Yun, Soo Ahn Chae
1Department of Pediatrics, College of Medicine, Chung-Ang University, Dongjak-Gu, Seoul, South Korea.
Insights
Peptic ulcer disease is rare in children and often diagnosed late. This case highlights duodenal perforation in a toddler, emphasizing the need for broader diagnostic considerations in pediatric abdominal emergencies.
Area of Science:
- Pediatric Gastroenterology
- Surgical Pediatrics
Background:
- Peptic ulcer disease is infrequently diagnosed in pediatric patients, often presenting only upon complication.
- It is typically not a primary consideration in the differential diagnosis of abdominal issues in children.
Observation:
- A 30-month-old boy presented with severe hematochezia and anemia, indicative of gastrointestinal bleeding.
- The patient had no prior medical history or recent use of corticosteroids or NSAIDs, and initially lacked typical symptoms like abdominal pain or distension.
Findings:
- Despite medical management, including arterial embolization, active bleeding from a duodenal perforation persisted.
- Surgical intervention via exploratory laparotomy revealed a discrete anterior perforation of the duodenal wall with active bleeding.
Implications:
- This case underscores the importance of considering peptic ulcer disease in the differential diagnosis of pediatric gastrointestinal bleeding, even in the absence of typical symptoms.
- Early recognition and appropriate management, including surgical intervention when necessary, are crucial for favorable outcomes in pediatric peptic ulcer complications.
Abstract:
Peptic ulcer disease is uncommon in children and rarely suspected as a cause of abdominal complaints in this age group; the diagnosis is therefore made almost exclusively when complications develop. Peptic ulcer disease is usually not considered in the differential diagnosis of pediatric patients. We present the case of a 30-month-old boy with duodenal perforation due to a peptic ulcer without a known etiology. The patient was admitted through the emergency department due to severe hematochezia and ongoing anemia; he presented with neither abdominal pain nor abdominal distension. There were no medical problems, and no drugs, such as corticosteroids or nonsteroidal anti-inflammatory drugs, had been prescribed or administered recently. We tried to control the active bleeding by medical treatment including arterial embolization, but the active bleeding was not controlled. Finally, an exploratory laparotomy was performed. A discrete anterior perforation with active bleeding of the duodenal wall was found. After the operation, there were no complications and the patient recovered fully.
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