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Perforated peptic ulcers in children: a systematic review
Stipe Vidović1, Sara Borović2, Marko Bašković3,4
1Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, Osijek, 31 000, Croatia.
Insights
Perforated peptic ulcers (PPU) in children are more common in males and the duodenum. Surgical repair, often with sutures, is effective, showing low complication and mortality rates.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Research
Background:
- Perforated peptic ulcers (PPU) are a serious complication of peptic ulcer disease with high mortality.
- No prior systematic reviews exist for PPU in the pediatric population.
- This review synthesizes current knowledge on PPU in children.
Purpose of the Study:
- To systematically review the literature on perforated peptic ulcers in children.
- To identify risk factors, common etiologies, and treatment strategies for pediatric PPU.
- To summarize outcomes, including complication and mortality rates.
Main Methods:
- A systematic literature search was conducted across four major databases (Web of Science, Scopus, PubMed, ScienceDirect).
- PRISMA guidelines were followed for study selection and data extraction.
- Included studies focused on perforated peptic ulcers in patients under 18 years old, published in English.
Main Results:
- Twelve studies comprising 239 pediatric patients were analyzed.
- PPU was more frequent in males (74.8%) and in the duodenum (73%).
- Surgical intervention, primarily open repair with sutures, was performed in 86.6% of cases, with a 3.8% mortality rate.
Conclusions:
- Perforated peptic ulcers in children predominantly affect males and the duodenum.
- Suturing with or without an omental patch is a common and effective treatment.
- Further research is needed for more robust evidence on pediatric PPU management.
Background:
Perforated peptic ulcers (PPU) represent a significant complication of peptic ulcers, associated with high mortality. As no systematic review of the literature on PPU in children currently exists, this study aims to summarize findings from studies focusing on its risk factors, etiology, treatment modalities, and outcomes.
Methods:
A systematic review was conducted following the PRISMA guidelines. A literature search was performed on 24 November 2024, using four electronic databases: Web of Science, Scopus, PubMed, and ScienceDirect. The inclusion criteria were studies published in English, focusing on perforated peptic ulcers in paediatric patients. The exclusion criteria were: studies published in languages other than English; publication formats such as conference abstracts, personal communications, and single case reports; studies focusing on non-perforated peptic ulcers; studies involving participants > 18 years; and studies reporting ulcer perforations outside the stomach or duodenum.
Results:
Out of 1963 records identified, 12 studies met the inclusion criteria and were included in the review. A total of 239 children with perforated peptic ulcers were analyzed, with a median age of 11 years (range 3.2-16.5 years). The results indicate that ulcer perforations were more prevalent in males (74.8%). Furthermore, duodenal perforations (73%) were more common than gastric perforations (27%). The most commonly reported symptoms were abdominal pain (n = 175, 73.2%), vomiting (n = 82, 34.3%), peritoneal signs (n = 79, 33%), and fever (n = 38, 15.9%). Subdiaphragmatic free air was detected in 141 patients (58.9%). Of the total number of patients, 207 (86.6%) were treated surgically, while 32 (13.4%) received conservative treatment. Regarding the surgical approach, most patients underwent open surgery (n = 143, 69%) compared to laparoscopic repair (n = 64, 31%). Among the surgical procedures, 114 involved simple sutures, with or without an omental patch. Postoperative complications were reported in 30 children (14.5%). Reoperation was required in 4 patients (1.9%), and mortality was recorded in 9 patients (3.8%).
Conclusions:
PPU was more prevalent in males and predominantly located in the duodenum. Ulcer suturing, with or without an omental patch, was the most commonly utilized treatment modality, demonstrating a relatively low complication rate. Further studies are needed to provide more comprehensive and unbiased evidence on PPU in children.
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