Duodenal perforation: an unusual complication of sickle cell anemia

Abstract

Duodenal perforation in childhood is a rare condition with a high mortality rate if not treated surgically. Primary gastroduodenal perforation is frequently associated with peptic ulcer and exhibits a positive family history. Helicobacter pylorus is the most significant agent. Secondary gastroduodenal perforation may be a finding of specific diseases, such as Crohn disease, or more rarely may be associated with diseases such as cystic fibrosis or sickle cell anemia. A 14-year-old boy presented with abdominal and back pain. The patient was operated on for acute abdomen and diagnosed with duodenal perforation. Helicobacter pylorus was negative. There was no risk factor to account for duodenal perforation other than sickle cell anemia. Surgical intervention was successful and without significant sequelae. Duodenal perforation is a rare entity described in patients with sickle cell anemia. To our knowledge, this is the first report of duodenal perforation in a patient sickle cell anemia.

CT of Gastrointestinal Vasoocclusive Crisis Complicating Sickle Cell Disease

“…8). A similar mechanism has been observed in ischemic changes within the stomach, where mucosal vulnerability from chronic ischemia leads to ulcers and even gastric perforation [29,30].…”

Perforated Duodenal Ulcer in a Young Nepalese Girl: An Infrequent Diagnosis for Age

“…PDU, the commoner of peptic perforation, is nevertheless an uncommon complication of PUD which in itself is an infrequent diagnosis in children [ 1 , 5 – 7 ]. The primary factors associated with PUD are blood group O, H. pylori infection, sickle cell disease, and Zollinger–Ellison syndrome [ 8 ]. Similarly, secondary factors implicated are medications (nonsteroidal anti-inflammatory drugs or steroids), severe systemic illness, neurotrauma, and burns [ 1 , 2 , 6 , 9 ].…”

Sickle cell anemia with perforated duodenal ulcer as a complication: when to suspect this rare entity?

“…Duodenal perforation in children is an even rarer condition and has high mortality rates if not treated promptly. It is most commonly caused in this age group by Helicobacter pylori infection – responsible for 56.8%-83.1% of cases in children living in the poorest regions of Brazil, and about 10% of cases in children under 10 years old [2] living in developed countries – or by systemic diseases such as Crohn's disease, cystic fibrosis or sickle cell disease [5] .…”