Clinical course and management of pediatric gastroduodenal perforation beyond neonatal period

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Critical Care Medicine

Background:

• Pediatric gastroduodenal perforation treatments and outcomes are not well-documented.
• This study addresses the limited data on pediatric gastroduodenal perforations.

Purpose of the Study:

• To compare the characteristics, treatments, and outcomes of gastroduodenal perforation in pediatric patients younger than 7 years versus those 7 years and older.
• To identify risk factors and treatment disparities in pediatric gastroduodenal perforation.

Main Methods:

• Retrospective analysis of 515 pediatric patients (28 days to 17 years) hospitalized for gastroduodenal perforation from July 2010 to March 2021.
• Comparison of patient demographics, comorbidities, treatment modalities (surgical and supportive), and outcomes between two age groups: <7 years (n=38) and ≥7 years (n=477).

Main Results:

• Children <7 years were more likely to be female, have comorbidities, and present with gastric perforation.
• Younger children (<7 years) received surgical treatment more often (79% vs. 55%), including open surgery (58% vs. 19%).
• Children <7 years experienced significantly higher rates of supportive care (mechanical ventilation, disseminated intravascular coagulation treatment, catecholamines, blood transfusion), intensive care unit admission, in-hospital mortality (5.3% vs. 0.4%), and morbidity (18% vs. 4.8%).

Conclusions:

• Pediatric gastroduodenal perforation in children <7 years is associated with a higher incidence of comorbidities.
• Younger children (<7 years) are more likely to undergo aggressive surgical and supportive treatments.
• Children <7 years with gastroduodenal perforation demonstrate poorer outcomes, including increased mortality and morbidity, compared to older children.