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Acute peptic ulcer in childhood. Emergency surgical therapy in 39 cases
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This study reports on 39 pediatric peptic ulcer cases, with most secondary to other conditions or medications. Surgical interventions were common for bleeding and perforation, with a low operative mortality rate.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Gastrointestinal Diseases
Background:
- Peptic ulcers are uncommon in children but can lead to serious complications.
- Understanding the etiology and management of pediatric peptic ulcers is crucial for improving patient outcomes.
Purpose of the Study:
- To analyze the clinical characteristics, diagnostic methods, surgical management, and outcomes of acute peptic ulcers in a pediatric population.
- To evaluate the efficacy and safety of different surgical approaches for bleeding and perforated peptic ulcers in children.
Main Methods:
- Retrospective review of 39 pediatric patients diagnosed with acute peptic ulcers.
- Analysis of patient demographics, underlying causes, presenting symptoms, diagnostic procedures (including endoscopy and radiography), surgical interventions, and follow-up data.
Main Results:
- Acute peptic ulcers occurred in 39 children, with 34 cases secondary to systemic disease or medications. Hemorrhage was present in 27 patients and perforation in 12.
- Endoscopy was key for diagnosing hemorrhage; radiography detected free air in all perforated cases.
- Surgical procedures included ligation, vagotomy, pyloroplasty, gastrectomy, and plication, with an operative mortality of 5.2% and no ulcer recurrence.
Conclusions:
- Acute peptic ulcers in children, often secondary to other conditions, require prompt diagnosis and management.
- Surgical interventions are effective in managing complications like hemorrhage and perforation, with a favorable long-term outlook.
- Multidisciplinary care is essential for optimizing outcomes in pediatric peptic ulcer disease.
Abstract:
Acute peptic ulcers occurred in 39 infants and children, 22 girls and 17 boys. Eleven patients were less than one year of age. Peptic ulcers were secondary to systemic disease or ulcerogenic medications in 34 cases. Hemorrhage occurred in 27 patients, perforation in 12. Endoscopy was the most useful diagnostic procedure for hemorrhage. Free air was seen on abdominal roentgenogram in all perforated patients. Ligation of the ulcer bed, vagotomy, and pyloroplasty were performed in 25 patients with bleeding. One patient required total gastrectomy. Simple plication was performed in nine patients with perforation. Plication was combined with pyloroplasty and tube duodenostomy in one patient each, and vagotomy and antrectomy were required in one patient. Operative mortality was 5.2%. There were two late deaths (Reye's syndrome and burn sepsis). No ulcer has recurred.