Ndour O, Bansouda J, Fall A F, Alumeti D M, Diouf C, Ngom G, Ndoye M
Service de chirurgie pédiatrique, CHU Aristide Le Dantec, BP 6863 Dakar-Etoile, Dakar, Sénégal.
Arch Pediatr. 2012 Oct;19(10):1065-9. doi: 10.1016/j.arcped.2012.07.009. Epub 2012 Sep 13.
Peritonitis due to gastroduodenal ulcer perforation disease is a rare entity in pediatric surgery. In Senegal, no study has been dedicated to ulcer complications in children. The aim of this study was to describe the epidemiology, diagnosis, and treatment of perforated peptic ulcer in patients less than 15 years old. This retrospective study was conducted in the Surgical Emergencies and Paediatric Surgery Department at Aristide Le Dantec University Hospital Center in Dakar, Senegal, during a period of 11 years (January 1999 to December 2010). We found 4 children who presented perforated gastroduodenal ulcer: 3 females and 1 male. The average age of these patients was 9 years (range, 7-14 years). No family history was found. We noted 3 cases of perforated duodenal ulcer and one perforated gastric ulcer. The clinical diagnosis was suspected based on a peritoneal irritation syndrome. A plain x-ray of the abdomen was taken in all patients, which objectified a pneumoperitoneum image in 3 cases. The leukocytosis was constant. Treatment in all patients consisted on pre-, intra-, and postoperative intensive care, supra- and infraumbilical midline laparotomy, which allowed us to perform a debridement-suture of the gap followed by epiploplasty and extensive washing with lukewarm physiologic serum. Adjuvant therapy based on anti-ulcer and antibiotic therapy was initiated. Bacteriological examination of peritoneal fluid isolated a polymicrobial flora. Helicobacter pylori was not isolated. Histological examination of the biopsied perforation edges showed a benign ulcer in all cases. The follow-up endoscopy was performed 4 weeks after surgery and showed cicatrization of the ulcer in all patients. After a mean of 2 years, no recurrence was noted. The gastric or duodenal ulcer in children is rare. It is often discovered at the stage of perforation, a complication for which the essential treatment is surgery. Routine screening would certainly help to reduce the risk of this complication.
胃十二指肠溃疡穿孔所致腹膜炎在小儿外科中是一种罕见疾病。在塞内加尔，尚无针对儿童溃疡并发症的研究。本研究旨在描述15岁以下患者消化性溃疡穿孔的流行病学、诊断及治疗情况。这项回顾性研究于1999年1月至2010年12月期间，在塞内加尔达喀尔的阿里斯蒂德·勒丹泰克大学医院中心的外科急诊与小儿外科进行。我们发现4例患有胃十二指肠溃疡穿孔的儿童：3名女性和1名男性。这些患者的平均年龄为9岁（范围7 - 14岁）。未发现家族史。我们记录到3例十二指肠溃疡穿孔和1例胃溃疡穿孔。临床诊断基于腹膜刺激征怀疑。所有患者均进行了腹部平片检查，其中3例显示有气腹影像。白细胞增多症持续存在。所有患者的治疗包括术前、术中和术后的重症监护，经脐上和脐下正中剖腹探查术，这使我们能够对创口进行清创缝合，随后进行网膜成形术并用温生理盐水广泛冲洗。启动了基于抗溃疡和抗生素治疗的辅助治疗。对腹膜液进行细菌学检查分离出多种微生物菌群。未分离出幽门螺杆菌。对活检的穿孔边缘进行组织学检查，所有病例均显示为良性溃疡。术后4周进行了随访内镜检查，所有患者溃疡均愈合。平均2年后，未发现复发。儿童胃或十二指肠溃疡罕见。通常在穿孔阶段才被发现，对于这种并发症，主要治疗方法是手术。常规筛查肯定有助于降低这种并发症的风险。
