Vaikų perforavusių skrandžio ir dvylikapirštės žarnos opų diagnostika ir gydymas

Abstract

ObjectivesPerforated peptic ulcer (PPU) is a rare but life-threatening surgical emergency in childhood. The aim of our study was to analyse the clinical features, diagnosis and management of PPU in children. MethodsThe data of children diagnosed with gastroduodenal PPU at Children's Surgery Department, Children's Hospital, Affiliate of Vilnius University Hospital Santariskiu Klinikos from 1994 to 2012 were reviewed. The patients' age, sex, anamnesis, clinical features, examination results, operative findings and methods, medication therapy and outcomes were assessed. Statistical analysis was performed using MS Excel. Results There were 14 (93.3%) males and one female aged 14 to 18 years (16.3 ± 1.3) included in the study. Twelve patients (80%) were diagnosed with gastric and 3 (20%) with duodenal PPU. Eleven patients (73.3%) had dyspepsia before PPU, of them 4 had a history of peptic ulcer disease. Most patients (46.6%) arrived to the hospital within 6 hours of symptom onset. All presented with severe epigastric pain, 8 (53.3%) with nausea and vomiting. Only one patient (6.6%) complained of melena. One (6.6%) suffered from epigastric pain radiating to the left shoulder. Physical examination revealed positive peritoneal signs in 13 patients (86.6%). Subdiaphragmatic free air was detected in 12 patients (80%). The mean duration of perforation was 34.47 ± 57.41 hours (2-178). Thirteen patients (86.6%) underwent laparotomy, 2 laparoscopic repair. The anterior wall of the prepyloric gastric region was the commonest perforation site (80%). Eight patients (53.4%) had a course of H. pylori eradication therapy. The average hospital stay was 10.6 ± 6.3 days (4-32). Fourteen patients (93.3%) had an uneventful postoperative period, one developed nephrotic range proteinuria. All recovered fully. Klinikinė praktika 39Perforated peptic ulcer in children: diagnosis and treatment ConclusionsGastroduodenal PPU should be suspected in adolescent boys with a sudden onset of severe abdominal pain, positive peritoneal signs, and confirmed by pneumoperitoneum in the plain X-ray. Simple closure and eradication of H. pylori (when infection confirmed) are mandatory for a complete recovery. Key words: gastric ulcer, duodenal ulcer, perforated peptic ulcer, children Darbo tikslasSkrandžio ar dvylikapirštės žarnos opos perforacija yra reta, tačiau gyvybei pavojinga vaikų būklė. Darbo tikslas -išanalizuoti vaikų perforavusių skrandžio ir dvylikapirštės žarnos opų kliniką, diagnostiką ir gydymą. Tyrimo medžiaga ir metodai Atlikta retrospektyvi ligonių, 1994-2012 m. gydytų Vaikų ligoninės VUL SK filialo Vaikų chirurgijos skyriuje, duomenų analizė. Vertinta ligonių amžius, lytis, anamnezė, klinika, fizinio ir instrumentinio ištyrimo duomenys, operacijos radiniai, metodai ir trukmė, medikamentinė terapija ir ankstyvosios komplikacijos. Statistinė duomenų analizė atlikta MS Excel programa. Rezultatai Buvo tirta 15 vaikų: 14 (93,3 %) berniukų ir 1 (6,6 %) mergaitė. Vidutinis ligonių amžius buvo 16,3±1,3 metų. Dvylikai (80 %) ligonių diagnozuota skr...