Is Duodenal Ulcer Perforation in Adolescents Different from Duodenal Ulcer Perforation in Adults?

Background: Duodenal ulcer perforations (DUP) are missed in the differential diagnosis of acute abdomen because they are less common in children than in adults. Delay in diagnosis may cause morbidity or even mortality. It was aimed to raise awareness about DUP in adolescent by comparing the data of adolescent cases treated in our clinic with the adult cases' data in the literature. Objectives: We reviewed the clinical characteristics of nine male patients with DUP, ages between 14 and 17 years, admitted to our clinic between January 2007 and June 2020 retrospectively. Literature data on DUP in adults were reviewed. Methods: The obtained data were compared with the data of adult patients in the literature. Results: Patients were reported to have symptoms such as abdominal pain and vomiting that lasted for 1-30 days on average in 8 patients, and nonsteroidal anti-inflamatory drugs were used all patients except 2 patients. There was diffuse tenderness at the abdomen in all of the remaining patients and in 7 patients intraabdominal free air was observed. Perforation was repaired with omentoplasty in all patients. Unlike the adult population, DUP adolescents are more related to NSAID use rather than Helicobacter pylori infection and complicated surgical techniques were not required because the cases were generally not complicated. Conclusions: Although it is rarely seen in adolescents and shows certain differences compared to adult patients, the anamnesis and physical examination of the patients should direct the physicians to the DUP. Differences from adult population should be considered in diagnosis and treatment.

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Study of factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation

Medpusle International Journal of Surgery ◽

10.26611/1061921 ◽

2021 ◽

Vol 19 (2) ◽

pp. 35-39

Author(s):

Pradeep Chandra Sharma ◽

Keyword(s):

Duodenal Ulcer ◽

Previous History ◽

Common Factors ◽

Duodenal Perforation ◽

High Morbidity ◽

Delayed Presentation ◽

Mortality And Morbidity ◽

Factors Affecting ◽

Ulcer Perforation ◽

Duodenal Ulcer Perforation

Background: Peptic ulcer disease in the general population had lifetime prevalence of 5-10% with incidence of 0.1–0.3% per year. Despite the tremendous improvement in preventive therapies, the rate of complication of this disease is still high and is burdened by high morbidity and mortality. In present study, we aimed to study factors affecting mortality and morbidity in patients presenting with peritonitis due to duodenal ulcer perforation at our tertiary hospital. Material and Methods: Present study was single-center, prospective, observational study conducted in patients admitted, diagnosed with duodenal ulcer perforation and surgically treated at our hospital. Results: In present study period total 56 patients were studied. All were male, most common age group was 51-60 years (37.5%) followed by 41-50 years (23.21%). Duration from onset of symptoms to admission was >24 hours (30.36%) in most of patients followed by 12-24 hours (28.57%). Most commons symptoms were pain in abdomen (100%), vomiting (100%). Anaemia (37.5%), LRTI and Pulmonary complications (19.64%), Diabetes mellitus (12.5%) and Hypertension (10.71%) were common comorbidities noted. Associated risk factors were previous history of PUD (41.07%), Alcohol use (64.29%), Cigarette smoking (51.79%) and Use of NSAIDs (12.5%). Presence of free gas under diaphragm was noted in 83.93% patients. Intraoperatively duodenal perforation diameter was 1–5 mm (60.71%) in most of patients followed by 6–10 mm (23.21%). Only 1 patient had duodenal perforation diameter was > 20mm. Common postoperative complications were wound infection (37.5%) and pulmonary infection (21.43%). In present study mortality within 1 month was noted in 13 patients (23.21%). Most common factors related to mortality were delayed presentation > 24 hours (61.54%), age > 60 years (46.15%), diabetes mellites (38.46%), Size of perforation > 1 cm (38.46%) and septicaemic shock (23.08%). Conclusion: Delayed presentation > 24 hours, age > 60 years size of perforation > 1 cm were common factors related to mortality in duodenal ulcer perforation patients.

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