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Peritonitis following gastroduodenal ulcer perforation in children: a report of 4 cases

O. Ndour, J. Bansouda, ALF. Fall, DM. Alumeti, C. Diouf, G. Ngom, M. Ndoye

Dakar - Sénégal

 

ABSTRACT

Introduction: The peritonitis following gastro-duodenal ulcer perforation is rare in children. The aim of this study is to describe its epidemiology, diagnosis and treatment.

Material and methods: This is a retrospective study concerning 4 cases of ulcer perforation in children between January 1996 and December 2007. The epidemiological, diagnostic and therapeutic aspects are discussed in this study.

Results: There were 3 girls and one boy. The median age of the children was 9 years. Two children presented chronic epigastric pain. There was no family history. The diagnosis of peritonitis was established preoperatively without knowing the exact cause. The surgical exploration found pus into the peritoneal cavity, three duodenal perforations and one gastric perforation. Bacteriological sampling of the pus and abdominal lavage were performed, the perforations were sutured. Helicobacter pylori was not isolated by the bacteriological examination or by the biopsies. The evolution under antibiotic treatment and anti-ulcer treatment was favourable in all the cases. The pathological examination of the biopsies taken from the edges of the perforationd showed benign lesions in all the cases. Control endoscopy was performed 4 weeks after surgery and showed ulcer cicatrisation. There was no relapse at 2 years follow-up.

Discussion: The peritonitis following gastro-duodenal ulcer perforation is rare in children. The diagnosis is rarely discussed preoperatively because of the low index of suspicion. Our treatment was perforation suture associated to antibiotic therapy and anti-ulcer medication although other authors advocate vagotomy in addition to suturing of the perforation.

Conclusion: In the context of chronic epigastric pain in children one must consider the gastro-duodenal ulcer and perform an endoscopy. This management should allow us to diminish the incidence of the ulcer complications in children.

 

Key words: chronic epigastric pain, peptic ulcer, perforation, peritonitis