Simple patch closure for perforated peptic ulcer in children followed by helicobacter pylori eradication

Tratamiento laparoscópico de úlcera duodenal perforada mediante parche de Graham en un paciente pediátrico

Introducción. La úlcera duodenal perforada es una entidad de etiología no clara que rara vez ocurre en la población pediátrica. Generalmente se diagnostica de manera intraoperatoria y el tratamiento ideal incluye el uso del parche de epiplón o de ser necesario, la resección quirúrgica. Caso clínico. Se presenta un paciente de 12 años con abdomen agudo y diagnóstico tomográfico prequirúrgico de úlcera duodenal perforada, tratado por vía laparoscópica con drenaje de peritonitis y parche de Graham. La evolución y el seguimiento posterior fueron adecuados. Discusión. La úlcera duodenal perforada es una entidad multifactorial, en la que se ha implicado el Helicobacter pylori. El diagnóstico preoperatorio es un reto y el tratamiento debe ser quirúrgico. Conclusiones. Cuando se logra establecer el diagnóstico preoperatorio, se puede realizar un abordaje laparoscópico y el uso del parche de Graham cuando las úlceras son menores de dos centímetros.

Analysis of Eradication, Recurrence and Levels of 25-hydroxyvitamin D3 and Interleukin-1β in paediatric patients with Helicobacter Pylori Infection-related Gastritis

Objective:

To study whether the levels of 25-hydroxyvitamin D₃ (25-(OH)D₃) and Interleukin-1β (IL-1β) are correlated to the eradication and recurrence of helicobacter pylori (Hp) in paediatric patients with Hp infection-related gastritis.

Methods:

A total of 142 paediatric patients with Hp infection-related gastritis from November 2017 to March 2018 in Baoding Children’s Hospital were selected as study subjectswere selected as study subjects and were followed up for one year. Paediatric patients were grouped and analyzed according to the effect of follow-up treatment and recurrence.

Results:

The levels of 25-(OH) D₃ in the non-eradication group were lower than those in the eradication group and the control group (F=27.087, P<0.05); the levels of IL-1β were higher than those in the eradication group and the control group (F=16.610, P<0.05). Recurrence during follow-up visits: The levels of 25-(OH) D₃ in the recurrence group were lower than those in the non-recurrence group and the control group (F=33.837, P<0.05); the levels of IL-1β in the recurrence group were higher than those in the non-recurrence group and the control group (F=7.896, P<0.05). Correlation analysis showed the levels of 25-(OH) D₃ and IL-1β in the eradication group and the non-eradication group were negatively correlated (r=-0.232, P<0.05); the levels of 25-(OH) D₃ and IL-1β in the recurrence group and the non-recurrence group were negatively correlated (r=-0.225, P<0.05).

Conclusion:

Relatively high levels of IL-1β may be correlated to the difficulty in eradicating the Hp infection in paediatric patients. Relatively low levels of 25-(OH) D₃ may be correlated to the difficulty in eradicating the Hp infection and recurrence in paediatric patients.

Acute abdomen and perforated duodenal ulcer in an adolescent: case report

El dolor abdominal agudo es uno de los principales motivos de consulta en los servicios de urgencias, sus causas son diversas y se dividen en quirúrgicas y médicas. En este artículo se hace mención a las causas quirúrgicas que pueden ser de tipo traumático, obstructivo o inflamatorio. En esta última categoría se encuentra la perforación de víscera hueca como complicación de ulcera duodenal, entidad poco frecuente en la edad pediátrica.Se presenta el caso de un adolescente de 14 años, previamente sano, quien consultó a urgencias de medicina general por dolor abdominal de inicio súbito y de rápido progreso en hipocondrio derecho, con irradiación a zona lumbar del mismo lado, asociado a síntomas vaso vágales. Se da manejo primario como urolitiasis.Ante el deterioro clínico y los signos evidentes de peritonitis generalizada, el paciente es llevado a laparoscopia diagnóstica que requiere conversión a laparotomía por cirugía pediátrica. El hallazgo quirúrgico es úlcera duodenal perforada como causa del cuadro clínico. Este reporte pretende mostrar la experiencia de los casos clínicos en los que se da un error diagnóstico inicial e incluir a la ulcera duodenal complicada como diagnóstico diferencial.

Unusual side effect of cannabis use: acute abdomen due to duodenal perforation

Background

The chronic use of synthetic cannabinoids (SCs) which has become an increasingly prevalent problem can rarely cause gastric and duodenal ulcer because of their effects on gastric secretion and emptying.

Since peptic ulcer disease (PUD) is a rarely seen entity in patients who consult to the emergency service with complaints of abdominal pain, most of the physicians do not suspect of this clinical diagnosis. Perforation is a mortal complication of PUD, and early diagnosis and emergency surgery are life-saving procedures.

Case presentation

A 16-year-old male patient was referred to our emergency service from another center with abdominal distension, complaints of abdominal pain, and bilious vomiting. His medical history revealed that he had been regularly using bonsai for the past 3 years. Plain abdominal radiograms of standing position revealed subdiaphragmatic free air, then we performed laparotomy which disclosed perforation of the first part of the duodenum. Surgical intervention with omental patch and primary closure (Graham patch) was successful. The patient who underwent nasogastric decompression and received antibiotherapy had not experienced any complication during the postoperative follow-up period.

Conclusion

Herein, as an unusual manifestation, a patient who developed duodenal perforation following chronic SC use has been reported.

In adolescent patients admitted with PUD or its complications to the emergency services, it is important to inquire for the use of addictive substances which are increasingly prevalent in order to determine the etiology.