Laparoscopic Graham Patch for Anterior Duodenal Perforation in a 6-Year-Old

Abstract

Peptic ulcer disease causing perforation is extremely rare in children and primarily affects teenagers. We present a case of a perforated peptic ulcer in a 6-year-old with abdominal pain and emesis with CT findings of moderate pneumoperitoneum and pelvic free fluid without a distinct cause. He was emergently transferred, found to be peritonitic, and taken to the operating room for diagnostic laparoscopy revealing an anterior duodenal ulcer, and underwent laparoscopic Graham patch repair. Postoperatively, the child had positive fecal antigen for H. pylori. He was treated with triple therapy and underwent subsequent testing to confirm eradication. Perforated peptic ulcer is an uncommon pediatric surgical problem, and imaging may not be diagnostic as in the case presented here. Thus, clinicians need to maintain a high index of suspicion when evaluating children with free air and a surgical abdomen in the setting of long-standing abdominal pain.

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

“…The simple suture technique to repair the PPU is usually recommended because of its feasibility and low procedure time ( 12 , 15 , 42 ). Pedicled omental patch repair is another favorable technique, especially in cases with a friable edge or a large perforation, which cannot allow the approximation of perforation edges ( 20 , 48 – 50 ). Regarding postoperative management for those PPU with H. pylori infection, proton pump inhibitors and eradication of H. pylori infection are essential to reduce peptic ulcer recurrence ( 40 , 51 , 52 ).…”