Abstract:
Objective: Peptic ulcer disease in children is rare. Therefore, the diagnosis can be missed until complications
such as perforation or hemorrhage occur. Few reports have investigated the procedures and outcomes of
children who have undergone operations for perforated duodenal ulcers. We report our experience with
the modified Graham technique for perforated duodenal ulcers in nine children and review the literature.
Methods: The records of patients operated on for a perforated duodenal ulcer in the last 8 years in
two pediatric surgery centers were evaluated retrospectively. Patient demographics, symptoms, time to
admission to hospital, operative findings, and postoperative clinical course were evaluated.
Results: Nine children (mean age 13.2 years, range 6–170 years) were included. All patients were admitted
in the first six hours after their abdominal pain started. In three patients, there was free air on plain
x-rays, while the x-rays were normal in six. All perforations were located on the anterior surface of the first
part of the duodenum and repaired with primary suturing and Graham patch omentoplasty. The recovery
was uneventful in all patients. In five patients, urea breath tests were performed postoperatively for
Helicobacter Pylori, and the results were positive. All patients underwent triple therapy with lansoprazole,
amoxicillin, and clarithromycin. The mean follow-up time was 58 (range 3–94) months.
Conclusions: Peptic ulcer perforation should be suspected in children who have acute abdominal pain and
peritoneal signs, especially when their suffering is intense. The simple patch repair and postoperative
triple therapy for Helicobacter Pylori are safe and satisfactory for treating peptic ulcer perforation in
children.
