Non-operative treatment for perforated gastro-duodenal peptic ulcer in Duchenne Muscular Dystrophy: a case report

Abstract

BackgroundClinical characteristics and complications of Duchenne muscular dystrophy caused by skeletal and cardiac muscle degeneration are well known. Gastro-intestinal involvement has also been recognised in these patients. However an acute perforated gastro-duodenal peptic ulcer has not been documented up to now.Case presentationA 26-year-old male with Duchenne muscular dystrophy with a clinical and radiographic diagnosis of acute perforated gastro-duodenal peptic ulcer is treated non-operatively with naso-gastric suction and intravenous medication. Gastrointestinal involvement in Duchenne muscular dystrophy and therapeutic considerations in a high risk patient are discussed.ConclusionNon-surgical treatment for perforated gastro-duodenal peptic ulcer should be considered in high risk patients, as is the case in patients with Duchenne muscular dystrophy. Patients must be carefully observed and operated on if non-operative treatment is unsuccessful.

Retracted: ‘The effects of Duchenne muscular dystrophy on the performance of the stomatognathic system: case–control study’, by Ferreira B., Da Silva G.P., Gonçalves C.R., et al.

“…5,6 These occurrences lead to the acute inflammation of the muscle fibers, which subsequently develops into a chronic inflammatory state that contributes to the progression of the pathology and generates a clinical course of disease with degeneration in skeletal and cardiac muscle. 7,8 This disease is characterized by the progressive loss of muscle strength, starting in the proximal region of the lower limbs. The loss of strength is accompanied by ambulation disturbances characterized by the Gowers' sign, with a significant lack of muscle strength in the hips and thighs.…”

Opportunities of conservative management of perforated ulcer

“…При постоянной активной аспирации из желудка J. Brinkman и соавт. [11] считают необходимым поддерживать давление в системе в пределах 20 см вод. ст.…”

“…J. Brinkman и соавт. [11] считают, что назогастральный зонд может быть удален на 5-е сутки госпитализации. H. Bertram [6], M. Hanumanthappa и соавт.…”

“…[14] и J. Brinkman и соавт. [11] лечили больных с перфоративной язвой с помощью сочетания цефураксима с метронидазолом. C. Marshall и соавт.…”

“…При этом доза ра-нитидина была различной -от 150 мг дважды в течение дня до 50 мг каждые 8 ч [12,26]. Некоторые авторы [11,20] применяли ингибиторы протонной помпы (омепразол) в суточной дозе 40 мг. Представляется более целесообраз-ным использовать ингибиторы протонной помпы, так как исследование, проведенное P. Bucher и соавт.…”