We report the case of a 28-month-old male child with no particular history who was admitted to the emergency room for severe abdominal pain associated with vomiting, asthenia and fever at 39.1˚C that had progressed for 4 days. He was conscious, polypneic at 32 cycles/min on admission. On palpation the abdomen was distended, painful as a whole, more pronounced in the epigastrium. There was abdominal contracture, generalized defense, a cry with sudden decompression of the umbilicus. On abdominal auscultation, there was a disappearance of prehepatic dullness, a decrease in the dullness of the flanks and absence of hydro-aeric noises. On the digital rectal examination, Douglas’s cul de sac was bulging and sensitive. An unprepared X-ray of the abdomen revealed diffuse grayness, lateral gas crescent pneumoperitoneum under diaphragm. The preoperative resuscitation consisted of the placement of a nasogastric tube, a urinary catheter, a peripheral venous route and the fluid electrolyte rebalancing adapted according to the blood ionogram, early antibiotic therapy with broad aero and anaerobic spectrum. Surgical management under general anesthesia found at laparotomy a perforation of the anterior surface of the duodenal bulb which we estimate to be 1 cm in diameter with fibrin deposits. The gesture was the toilet of the peritoneal cavity; suture of the bank and the operative consequences were simple.
References
[1]
Libeer, F., Vanhamel, N., Huyghe, M. and Verlinden, E. (2007) Spontaneous Gastric Rupture in Non-Neonatal Children: A Case Report. Acta Chirurgica Belgica, 107, 560-563. https://doi.org/10.1080/00015458.2007.11680124
[2]
Aydin, M., Deveci, U., Taskin, E., Bakal, U. and Kilic, M. (2015) Percutaneous Peritoneal Drainage in an Isolated Neonatal Gastric Perforation. World Journal of Gastroenterology, 21, 12987-12988. http://dx.doi.org/10.3748/wjg.v21.i45.12987
[3]
Holgersen, L.O. (1981) The Etiology of Spontaneous Gastric Perforation in the Newborn: A Reassessment. Journal of Pediatric Surgery, 16, 608-613. https://doi.org/10.1016/0022-3468(81)90014-2
[4]
Tan, C.E., Kiely, E.M., Agrawal, M., Brereton, R.J. and Spitz, L. (1989) Neonatal Gastrointestinal Perforation. Journal of Pediatric Surgery, 24, 888-892. https://doi.org/10.1016/S0022-3468(89)80589-5
[5]
Semel, L. and Frittelli, G. (1981) Gastric Rupture from Blunt Abdominal Trauma. New York State Journal of Medicine, 81, 938-939.
[6]
Paret, G., Yahav, J., Cohen, O., Nass, D.S. and Barzilay, Z. (1990) Chickenpox and Perforation of the Stomach. Journal of Pediatric Gastroenterology and Nutrition, 10, 121-125. https://doi.org/10.1097/00005176-199001000-00024
[7]
Knight, K.M. and Doucet, H.J. (1987) Gastric Rupture and Death Caused by Syrup of Ipecac. Southern Medical Journal, 80, 786-787. https://doi.org/10.1097/00007611-198706000-00031
[8]
Fukata, R., Tokiwa, K., Nakamura, K., Yanagihara, J., Iwai, N. and Hosoi, S. (1993) Idiopathic Gastric Rupture in a 19 Month Old Girl (in Japanese with English Summary). Journal of the Japanese Society of Pediatric Surgeons, 25, 343-346.
[9]
Shigeta, H., Kuroda, O., Kawamoto, T., Hotta, T., Suzuki, H., Goto, M., Kajimura, M., Kawagoe, K. and Hurumoto, M. (1981) Idiopathic Gastric Perforation in a 2-Year-Old Woman (in Japanese with English Summary). Journal of the Japanese Society of Pediatric Surgeons, 13, 1533-1537.
[10]
Mitani, K., Shimoji, H., Kondou, K., Matsushita, K., Koizumi, M., Yamashita, K. and Kobayashi, S. (1992) Idiopathic Gastric Rupture in Childhood (in Japanese). Gastroenterological Surgery, 15, 1535-1538.
[11]
Bott, L., Vara, D., Missotte, I. and Ménager, C. (2003) Perforation of a Child’s Gastric Ulcer: A Rare Complication, Based on One Case. Archives de Pédiatrie, 10, 31-33. https://doi.org/10.1016/S0929-693X(03)00218-5
[12]
Huang, S.C., Sheu, B.S., Lee, S.C., Yang, H.-B. and Yang, Y.-J. (2010) Etiology and Treatment of Childhood Peptic Ulcer Disease in Taiwan: A Single Center 9 Year Experience. Journal of the Formosan Medical Association, 109, 75-81. https://doi.org/10.1016/S0929-6646(10)60024-1
[13]
Ndour, O., Bansouda, J., Fall, A.F., Alumeti, D.M., Diouf, C., Ngom, G., et al. (2012) Peritonitis from Peptic Ulcer Perforation in Children: About 4 Observations. Archives de Pédiatrie, 19, 1065-1069. https://doi.org/10.1016/j.arcped.2012.07.009
[14]
Motil, K.J., Schultz, R.J., Browning, K., Trautwein, L. and Glaze, D.G. (1999) Oropharyngeal Dysfunction and Gastroesophageal Dysmotility Are Present in Girls and Women with Rett Syndrome. Journal of Pediatric Gastroenterology & Nutrition, 29, 31-37. https://doi.org/10.1097/00005176-199907000-00010
[15]
Guven, A., Demirbag, S., Atabek, C. and Ozturk, H. (2007) Spontaneous Gastric Perforation in a Child with Burkitt Lymphoma. Journal of Pediatric Hematology/Oncology, 29, 862-864. https://doi.org/10.1097/MPH.0b013e31815815e2
[16]
Terui, K., Iwai, J., Yamada, S., Takenouchi, A., Nakata, M., Komatsu, S., et al. (2012) Etiology of Neonatal Gastric Perforation: A Review of 20 Years of Experience. Pediatric Surgery International, 28, 9-14. https://doi.org/10.1007/s00383-011-3003-4
[17]
Duran, R., Inan, M., Vatansever, U., Aladağ, N. and Acunaş, B. (2007) Etiology of Neonatal Gastric Perforations: Review of 10 Years’ Experience. Pediatrics International, 49, 626-630. https://doi.org/10.1111/j.1442-200X.2007.02427.x
[18]
Lin, C.M., Lee, H.C., Kao, H.A., Hung, H.Y., Hsu, C.H., Yeung, C.Y., et al. (2008) Neonatal Gastric Perforation: Report of 15 Cases and Review of the Literature. Pediatrics & Neonatology, 49, 65-70. https://doi.org/10.1016/S1875-9572(08)60015-7
[19]
Sato, M., Hamada, Y., Kohno, M., Ise, K., Uchida, K., Ogata, H., et al. (2017) Neonatal Gastrointestinal Perforation in Japan: A National Survey. Pediatric Surgery International, 33, 33-41. https://doi.org/10.1007/s00383-016-3985-z
[20]
Schinasi, D.A. and Ellison, A.M. (2010) Spontaneous Gastric Perforation in a Child with Heterotaxy Syndrome. Pediatric Emergency Care, 26, 925-927. https://doi.org/10.1097/PEC.0b013e3181fe9175
[21]
Qin, H., Yao, H. and Zhang, J. (2000) Gastric Rupture Caused by Acute Gastric Distension in Non-Neonatal Children: Clinical Analysis of 3 Cases. Chinese Medical Journal, 113, 1147-1149.
[22]
Iacusso, C., Boscarelli, A., Fusaro, F., Bagolan, P. and Morini, F. (2018) Pathogenetic and Prognostic Factors for Neonatal Gastric Perforation: Personal Experience and Systematic Review of the Literature. Frontiers in Pediatrics, 6, 61. https://doi.org/10.3389/fped.2018.00061
