Experience in diagnosis and treatment of duodenal ulcer perforation in children

Abstract

Background This study aims to summarize our experience in diagnosis and treatment of pediatric duodenal ulcer perforation in a National Center for Children’s Health. Methods Fifty-two children with duodenal perforation hospitalized in Beijing Children’s Hospital Affiliated to Capital Medical University from January 2007 to December 2021 were retrospectively collected. According to the inclusion and exclusion criteria, patients with duodenal ulcer perforation were included in the group. They were divided into the surgery group and the conservative group according to whether they received surgery. Results A total of 45 cases (35 males and 10 females) were included, with a median age of 13.0 (0.3–15.4) years. Forty cases (40/45, 88.9%) were over 6 years old, and 31 (31/45, 68.9%) were over 12 years old. Among the 45 cases, 32 cases (32/45, 71.1%) were examined for Helicobacter pylori (HP), and 25 (25/32, 78.1%) were positive. There were 13 cases in the surgery group and 32 cases in the conservative group, without a significant difference in age between the two groups (P = 0.625). All cases in the surgery group and the conservative group started with abdominal pain. The proportion of history time within 24 h in the two groups was 6/13 and 12/32 (P = 0.739), and the proportion of fever was 11/13 and 21/32 (P = 0.362). The proportion of pneumoperitoneum in the surgery group was higher than that in the conservative group (12/13 vs. 15/32, P = 0.013). The fasting days in the surgery group were shorter than those in the conservative group (7.7 ± 2.92 vs. 10.3 ± 2.78 days, P = 0.014). There was no significant difference in the total hospital stay (13.6 ± 5.60 vs14.8 ± 4.60 days, P = 0.531). The operation methods used in the surgery group were all simple sutures through laparotomy (9 cases) or laparoscopy (4 cases). All patients recovered smoothly after surgery. Conclusion Duodenal ulcer perforation in children is more common in adolescents, and HP infection is the main cause. Conservative treatment is safe and feasible, but the fasting time is longer than the surgery group. A simple suture is the main management for the surgery group.

Duodenal perforation in children: must surgery be performed?

“…The 5 cases with successful conservative treatment had fasting time of 10.0 ± 2.55 days, gastrointestinal decompression time of 6.2 ± 3.56 days, and total hospitalization time of 13.0 ± 2.83 days. Shen reported that 32 children with duodenal perforation underwent conservative treatment, fasting for 10.3 ± 2.78 days, and a total hospital stay of 14.8 ± 4.60 days [20] . It can be seen that the recovery time of conservative treatment is similar.…”

Gastrointestinal contrast-enhanced ultrasonography for diagnosis and treatment of peptic ulcer in children

“…Moreover, the proportion of perforation, massive hemorrhage, severe anemia and other serious complications of peptic ulcer in children is higher than in adults[ 15 , 16 ]. It has been reported that most cases of duodenal ulcer perforation are in teenagers; less than half the cases have a history of abdominal pain, and most of them have ulcer perforation at the beginning of acute disease, which may be related to the inability of children to accurately describe abdominal discomfort[ 17 ].…”

Experience of management of pediatric upper gastrointestinal perforations: a series of 30 cases

“…Ultrasonography, a commonly used tool for differential diagnosis in pediatric acute abdomen, was performed in approximately half of the patients. The results showed a higher sensitivity of accurate diagnosis; this may be because highly skilled sonographers performed the ultrasonography ( 16 ). Ultrasonographic examination may reveal gas accumulation or free air in front of the liver, discontinuous gastroduodenal wall, swollen soft tissue, and free ascites ( 16 , 20 ).…”

“…The results showed a higher sensitivity of accurate diagnosis; this may be because highly skilled sonographers performed the ultrasonography ( 16 ). Ultrasonographic examination may reveal gas accumulation or free air in front of the liver, discontinuous gastroduodenal wall, swollen soft tissue, and free ascites ( 16 , 20 ). If radiograms present no free gas, UGI perforation could not be ruled out.…”

“…However, managing pediatric UGI perforation, including non-surgical and surgical treatments, remains a challenge in clinical practice. The general principles for these severe conditions are prompt diagnosis and effective treatment, although there is little standardization due to varied etiologies, different perforation sites and sizes, various clinical scenarios, and varied diagnostic methods ( 15 , 16 ).…”