Perforated peptic ulcer in children: A 20-year experience

BACKGROUND: Although the detection of pediatric peptic ulcer disease (PUD) has recently been increasing, perforated peptic ulcer (PPU) in children is rare. We report our experience with PPU in children. MATERIALS AND METHODS: The charts of children diagnosed with PPU at our hospital from January 1986 to June 2005 were reviewed. Data were obtained on demographics, coexisting clinical events, perforation sites, delay in surgery, operative findings and methods, and outcomes. The data were analyzed using the χ, Student t test, and multivariate logistic regression for possible risk factors. RESULTS: There were 42 male and 10 female patients aged 2 to 18 years (mean, 14.2 years) included in the study. Forty-seven patients were adolescents (90%). Eight patients had coexisting clinical events before PPU. All of the patients manifested acute abdominal pain. Forty-nine patients (94.2%) had peritoneal signs. Radiography showed subdiaphragmatic free air in 43 patients (82.7%); this was the most important tool for establishing diagnosis. Nine patients (17.3%) had postoperative complications. Two patients died (3.8%). Univariate analysis showed that poor outcome was significantly associated with female sex, more coexisting clinical events, no evidence of chronic ulcer, and treatment by simple suture (P < 0.05). Only female sex and simple suture remained statistically significant in multivariate analysis. Although delay in surgery (>12 hours) was not significantly related to complications, there was a greater tendency toward the development of complications. CONCLUSIONS: PPU should be suspected in adolescents who manifest acute abdominal pain and have peritoneal signs. Children with PPU have a more favorable outcome than adults.