Perforated gastric ulcer: An unusual cause of peritonitis in children

Abstract

Perforated gastric ulcer is a particularly rare cause of peritonitis in children. Only few cases have been reported in the literature. It is a serious emergency condition which can be overlooked leading to life-threatening consequences. We report a case of a 12-year-old girl who presented with acute abdominal pain and signs of peritonitis. Surgical exploration found a gastric perforation on the anterior side of the antrum. Primary repair of the perforation was performed after thorough decontamination and taking biopsies from its edges. The post-operative period was uneventful. Helicobacter pylori test was negative. Histopathology result was suggestive of ulceration in the gastric wall and did not isolate H. pylori. Gastro-duodenal ulcer perforation should be considered in the differential diagnosis of children presenting with acute abdomen, especially when imaging showing pneumoperitoneum.

Keywords: Children; gastric ulcer; perforation; peritonitis; pneumoperitoneum.

Figure 1

Erect abdominal X-ray covering the lung bases showing pneumoperitoneum beneath the right and left hemidiaphragm. Short segment of adynamic ileus (sentinel loop)

Figure 2

Axial non-contrast computed tomography of the abdomen showed several locules of free intra-peritoneal air within the upper abdomen, with a large amount of free air along the anterior aspect of the liver surface (yellow arrow) with peri-splenic ascites (green arrow). Normal appearance of the liver and spleen

Figure 3

Axial view of contrast computed tomography scan: Free intra-peritoneal fluid in right para-colic gutters (yellow arrow)

Figure 4

Axial view of contrast computed tomography scan: Free intra-peritoneal fluid is seen also in the left iliac fossa (yellow arrow)

Figure 5

Intraoperative view showing a gastric perforation of nearly 1.5 cm on the anterior side of the antrum

Figure 6

Intra-operative view at the end of surgery after closure of the perforation