Atypical presentation of perforated peptic ulcer disease in a 12-year-old boy

Abstract

A 12-year-old boy was referred to the surgical unit with 4 h history of severe lower abdominal pain and bilious vomiting. No other symptoms were reported and there was no significant medical or family history. Examination revealed tenderness in the lower abdomen, in particular the left iliac fossa. His white cell count was elevated at 19.6×10(9)/L, with a predominant neutrophilia of 15.8×10(9)/L and a C reactive protein of <0.3 mg/L. An abdominal X-ray revealed intraperitoneal gas and a chest X-ray identified free air under both hemidiaphragms. Subsequent diagnostic laparoscopy identified a perforated duodenal ulcer that was repaired by means of an omental patch. The case illustrates that although uncommon, alternate diagnoses must be borne in mind in children presenting with lower abdominal pain and diagnostic laparoscopy is a useful tool in children with visceral perforation as it avoids treatment delays and exposure to excess radiation.

Tratamiento laparoscópico de úlcera duodenal perforada mediante parche de Graham en un paciente pediátrico

“…Se reporta una mortalidad del 8-25 % en la población general 6,7 . En una revisión de 20 años realizada por Hua MC y colaboradores encontraron que la UDP se presentó en adolescentes entre 12-15 años, con mayor prevalencia en el sexo masculino, como ocurrió en nuestro caso 8,9,10 .…”

Duodenal Ulcus Perforation: An Unusual Cause of Acute Abdomen in Pediatrics

“…Yadav et al (2) revealed the presence of duodenal perforation in a 6.5-year-old case with thalassemia major under deferasirox therapy. Mbarushimana et al (10) reported a patient who consulted them with complaints of lower abdominal pain, and vomiting lasting for 4 hours. The patient's radiograms revealed subdiaphragmatic free air which necessitated surgical exploration with resultant disclosure of duodenal ulcer perforation.…”

Valentino’s syndrome: a bizarre clinical presentation

“…The chemical fluid from the ulcer streams along the right paracolic gutter to the right iliac fossa, causing peritoneal irritation and consequent chemical appendicitis [ 3 ]. In patients presenting with right lower quadrant pain, including Valentino’s syndrome as an uncommon differential is critical [ 4 ].…”