Duodenal ulcer disease in chidren.

Eleven cases of chronic duodenal ulcer in children were subjected to surgical treatment in a period of 7 years. The diagnosis was based on typical peptic ulcer symptoms, hyperchlorhydria, and barium meal x-ray studies delineating a duodenal bulb deformity with an ulcer crater in 8 patients. Three cases of duodenal ulcer perforation in infants were diagnosed at aparotomy for peritonitis with pneumoperitoneum. All the patients hailed from the rgion of Assam, India, where peptic ulcer is prevalent. A positive family history of peptic ulcer in 5 patients, blood group O in 7 patients, and the regional diet were considered to be predisposing factors. Medical treatment consisting of a bland diet, sedatives, antispasmodics, and a brief hospital stay failed to provide permanent relief of symptoms. Truncal vagotomy with a drainage procedure was done in 8 patients with no deaths. However, simple closure of the perforation in the 3 infants resulted in fatalities due to fulminant septicemia. The patients were followed up for 1-8 years. Six patients had permanent relief of symptoms. Two patients occasionally complained of epigastric fullness and eructation. They showed normal growth, gain in weight and hemoglobin levels, and had no recurrence. We believe that operative treatment is preferable to medical management of chronic duodenal ulcer in children.