Duodenal perforation in an infant with rotavirus gastroenteritis

Abstract

SUMMARYWe describe for the first time a case of an infant with rotavirus gastroenteritis complicated by a duodenal perforation. Awareness of the perforation risk may prevent severe or lethal outcomes in this common infection among infants and children. BACKGROUND

Duodenal perforation associated with norovirus and rotavirus gastroenteritis

“…Mural thickening, fibrosis, and necrosis of the intestine have been documented in three preterm babies with colonic perforation associated with NoV gastroenteritis 3 . As was the case in the patients reported above, perforations of the stomach and duodenum without any associated pathological changes around the perforation sites have been reported in two infants with RV gastroenteritis 4 , 5 . On the other hand, one report on spontaneous bowel perforation in children with acute viral gastroenteritis has described mucosal lesions such as focal ulcer or diffuse inflammation and necrosis around the perforation sites 7 .…”

“…However, diarrhea-associated death in children under 5 years of age is high (20%) in developing countries 2 . Few pediatric cases of bowel perforation associated with gastroenteritis due to these viruses including a case of duodenal perforation in an infant with RV gastroenteritis have also been reported 3 – 5 . However, to our knowledge, duodenal perforation associated with NoV gastroenteritis has not been described in children.…”

Three infants with rotavirus gastroenteritis complicated by severe gastrointestinal bleeding

“…Taken together, these findings highlight the need for physicians to monitor RV gastroenteritis patients for gastrointestinal bleeding and the importance for elucidation of clinical features and pathophysiology of this complication. Recently, duodenal perforation has been demonstrated in the RV gastroenteritis patients [Stabell et al, 2013;Ueda et al, 2013]. Although one of the three present cases demonstrated fatal outcome, no intestinal perforation was observed in these cases.…”

A Child with Severe Malaria Presenting with Acute Surgical Abdomen (Duodenal Perforation)

“…Malarial parasites mostly infect mature enterocytes of the duodenal villi and the host's inability to eliminate the parasites due to limited systemic and intestinal immunity during illness [10]. Severe dehydration and shock associated with acute diarrhea may cause severe acute bowel ischemia, leading to bowel perforation [12, 13]. It is possible that acute and transient ischemia of the small intestine caused by severe dehydration could have triggered duodenal perforation in our case.…”

“…Primary ulcers have a male preponderance (male/female 4 : 1), often present at a mean age of 8 years, occur commonly in children having blood group O, and are associated with Helicobacter pylori infection [1, 8]. Secondary ulcers are precipitated by physiological stress, severe burns (Curling's ulcer), raised intracranial pressure (Cushing's ulcer) [9], drugs (steroids, nonsteroidal anti-inflammatory drugs), and other severe illnesses (gastroenteritis, shock, sepsis, or cancer) [10–13]. Primary peptic ulcers rarely present with perforation whereas secondary ulcers present commonly with perforation and hemorrhage.…”