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Experience in diagnosis and treatment of duodenal ulcer perforation in children
Qiulong Shen1, Tingting Liu1, Siwei Wang2
1Department of Emergency Surgery, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi St, Xicheng District, Beijing, 100045, China.
Insights
Pediatric duodenal ulcer perforation, often caused by Helicobacter pylori (HP) infection, is common in adolescents. While conservative treatment is safe, surgery offers shorter fasting times, with simple sutures being the primary surgical approach.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Medicine
Background:
- Duodenal ulcer perforation is a serious condition in children.
- Understanding its diagnosis and treatment is crucial for pediatric healthcare centers.
Purpose of the Study:
- To summarize the experience in diagnosing and treating pediatric duodenal ulcer perforation.
- To compare outcomes of surgical versus conservative management.
Main Methods:
- Retrospective collection of 52 pediatric duodenal perforation cases from 2007-2021.
- Inclusion criteria applied to identify duodenal ulcer perforation cases.
- Patients divided into surgery (13) and conservative (32) groups.
Main Results:
- 45 cases included, median age 13 years; 71.1% tested positive for Helicobacter pylori (HP).
- Higher pneumoperitoneum rate in the surgery group (P=0.013).
- Shorter fasting days in surgery group (7.7 days) vs. conservative group (10.3 days) (P=0.014).
Conclusions:
- Adolescents are more prone to duodenal ulcer perforation, with HP infection being a primary cause.
- Conservative treatment is safe and effective, though associated with longer fasting periods.
- Simple suture repair is the standard surgical intervention for pediatric duodenal ulcer perforation.
Background:
This study aims to summarize our experience in diagnosis and treatment of pediatric duodenal ulcer perforation in a National Center for Children's Health.
Methods:
Fifty-two children with duodenal perforation hospitalized in Beijing Children's Hospital Affiliated to Capital Medical University from January 2007 to December 2021 were retrospectively collected. According to the inclusion and exclusion criteria, patients with duodenal ulcer perforation were included in the group. They were divided into the surgery group and the conservative group according to whether they received surgery.
Results:
A total of 45 cases (35 males and 10 females) were included, with a median age of 13.0 (0.3-15.4) years. Forty cases (40/45, 88.9%) were over 6 years old, and 31 (31/45, 68.9%) were over 12 years old. Among the 45 cases, 32 cases (32/45, 71.1%) were examined for Helicobacter pylori (HP), and 25 (25/32, 78.1%) were positive. There were 13 cases in the surgery group and 32 cases in the conservative group, without a significant difference in age between the two groups (P = 0.625). All cases in the surgery group and the conservative group started with abdominal pain. The proportion of history time within 24 h in the two groups was 6/13 and 12/32 (P = 0.739), and the proportion of fever was 11/13 and 21/32 (P = 0.362). The proportion of pneumoperitoneum in the surgery group was higher than that in the conservative group (12/13 vs. 15/32, P = 0.013). The fasting days in the surgery group were shorter than those in the conservative group (7.7 ± 2.92 vs. 10.3 ± 2.78 days, P = 0.014). There was no significant difference in the total hospital stay (13.6 ± 5.60 vs14.8 ± 4.60 days, P = 0.531). The operation methods used in the surgery group were all simple sutures through laparotomy (9 cases) or laparoscopy (4 cases). All patients recovered smoothly after surgery.
Conclusion:
Duodenal ulcer perforation in children is more common in adolescents, and HP infection is the main cause. Conservative treatment is safe and feasible, but the fasting time is longer than the surgery group. A simple suture is the main management for the surgery group.
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