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Perforated peptic ulcer disease in children: association of corticosteroid therapy
S W Bickler1, M W Harrison, J R Campbell
1Department of Surgery, School of Medicine, Oregon Health Sciences University, Portland 97201.
Insights
Corticosteroid use in children with severe underlying diseases is linked to perforated peptic ulcers. Prophylaxis is recommended for these children to prevent serious gastrointestinal complications.
Area of Science:
- Pediatric Gastroenterology
- Surgical Outcomes
- Pharmacovigilance
Background:
- Perforated peptic ulcer disease (PUD) is a rare but serious condition in children.
- Children with severe underlying diseases are at increased risk.
- Corticosteroids are frequently used in managing chronic pediatric illnesses.
Observation:
- Four pediatric cases of perforated PUD were identified over 15 years.
- All patients had severe comorbidities and were on corticosteroid therapy.
- Presenting symptoms included signs of a perforated viscus with pneumoperitoneum.
Findings:
- Simple closure and omental patching of the perforated ulcer led to successful outcomes with no mortality or morbidity.
- No recurrence of ulcers was observed post-operatively.
- Literature review indicated corticosteroids were associated with 17.8% of pediatric perforated PUD cases.
Implications:
- Corticosteroid therapy may contribute to the risk of PUD in vulnerable pediatric populations.
- Prophylactic measures against PUD should be considered for all children receiving corticosteroids.
- Effective surgical management (simple closure and omental patching) offers favorable outcomes for perforated PUD in children.
Abstract:
Four children were treated at the Oregon Health Sciences University for perforated peptic ulcer disease over the last 15 years. All children were being treated for other severe underlying diseases at the time of perforation. All of the children were receiving corticosteroids; one was receiving ulcer prophylaxis. Presenting symptoms were those of a perforated viscus, and pneumoperitoneum was present in all patients. Simple closure and omental patching of the ulcer resulted in no operative mortality or morbidity. None of the ulcers have recurred. In reviewing the literature, corticosteroids were associated with perforated peptic ulcer disease in 17.8% of children with perforated peptic ulcer. Despite controversy regarding the role of corticosteroids in the causation of peptic ulcer, we recommend prophylaxis for all children receiving corticosteroids.