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[Recurrent secondary stomach ulcer in a boy 3 months of age with osteogenesis imperfecta]
Insights
A 3-month-old boy with osteogenesis imperfecta experienced recurrent gastric bleeding from ulcers. He later developed hypertrophic pyloric stenosis, and surgery led to recovery, suggesting multiple ulcerogenic factors in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Surgery
- Pediatric Orthopedics
Background:
- Osteogenesis imperfecta (OI) is a genetic disorder characterized by fragile bones and frequent fractures.
- Recurrent gastrointestinal bleeding in infants can be challenging to diagnose and manage.
- Secondary peptic ulcers in pediatric patients may arise from various underlying conditions.
Observation:
- A 3-month-old infant with OI and multiple fractures presented with vomiting and gastrointestinal bleeding.
- Endoscopy confirmed a gastric ulcer, but radiography failed to visualize it.
- Despite H2-antagonist and antacid treatment, bleeding recurred three months later.
Findings:
- The patient subsequently developed hypertrophic pyloric stenosis.
- Pyloromyotomy was performed, leading to complete recovery without further bleeding episodes.
- This case highlights the potential for multiple, concurrent ulcerogenic factors in pediatric patients.
Implications:
- Recurrent secondary ulcers in pediatric patients, particularly those with underlying conditions like OI, necessitate a comprehensive evaluation for multiple contributing factors.
- Early recognition and management of conditions like hypertrophic pyloric stenosis are crucial in cases of refractory gastrointestinal bleeding.
- This case underscores the importance of considering surgical etiologies in pediatric gastrointestinal bleeding that is unresponsive to medical management.
Abstract:
A case is described where a 3-month-old boy who had osteogenesis imperfecta with multiple fractures presented with vomiting and bleeding. A gastric ulcer was diagnosed by endoscopy but could not be visualized by repeated radiography. In spite of adequate treatment with H2-antagonists and antacids the bleeding recurred three months later. Development of hypertrophic pyloric stenosis was diagnosed and pyloromyotomy was performed after which the patient recovered without further recurrences. This case suggests that multiple ulcerogenic factors should considered and treated in pediatric patients with recurrent secondary ulcers in spite of appropriate treatment.