Diagnostic Difficulties of Spontaneous Gastric Peforation in Adolescents

Year 2019, Volume: 1 Issue: 1, 7 - 10, 23.04.2019

Zeliha Akış Yıldız , Ceyhan Şahin , Mehmet Arpacık , Hayriye Nihan Ayyıldız Aytekin Kaymakçı

https://izlik.org/JA99FJ73HW

Abstract

Objective:
Spontaneous gastric
perforation (SGP) in adolescents is very rare. This study aims to evaluate the
diagnostic difficulties and misdiagnoses associated with SGP.

Methods: The medical records of patients that
underwent surgery for a gastric perforation over the past 2 years at our paediatric
surgery clinic were evaluated retrospectively. Patient demographics, symptoms,
diagnostic evaluation, diagnostic difficulties, operative findings, and post operative
clinical course were evaluated.

Results: Seven patients were identified as
having SGP. All of the patients were adolescents. Only 1 patient had a history
of gastritis; the other 6 patients did not have a history of any disease,
surgery or trauma. Radiological evidence of pneumoperitoneum using upright radiography
was only found in 1 patient (16.6%). One patient was misdiagnosed and thought to
have appendicitis. In 2 patients, the diagnosis was unclear, so diagnostic laparoscopy
was performed.

Conclusion:
SGP can be seen in
adolescents. However, sometimes it is difficult to diagnose. Even if all the
imaging studies and laboratory tests are normal, if there is a sign of
peritonitis upon physical examination, diagnostic laparoscopy could be
performed.

Keywords

gastric perforation , spontaneous gastric perforation

References

• REFERENCES[1] Seifarth FG, Soldes OS. Congenital anomalies and surgical disorders of the stomach. In: Wyllie R, Hyams J, Kay M. editors. Pediatric Gastrointestinal and Liver Disease. 5th ed. Philadelphia: Elsevier Saunders; 2016. 25:284–293.
• [2] Akalonu A, Yasrebi M, MolleRios Z. Spontaneous gastric perforation in two adolescents. Am J Case Rep. 2016;17:694–698.
• [3] Curt S. Koontz, Mark L. Wulkan. Lesions of the stomach. In: Holcomb, GW, Murphy JP, Ostlie DJ. editors. Ashcraft’s Pediatric Surgery. 6th ed. Philadelphia: Elsevier Saunders; 2014. 29:403–413.
• [4] Hua MC, Kong MS, Lai MW, Luo CC. Perforated peptic ulcer in children: a 20-year experience. J Pediatr Gastroenterol Nutr.2007; 45:71–74.
• [5] Restrepo R, Marin DV. Acquired disorders. In: Coley BD, Bates DG, Faerber EN, Hernanz Schulman M, Kan H, Lee EY, Panigrahy A, Rigsby C. editors. Caffey’s Pediatric Diagnostic Imaging. 12th ed. Philadelphia: Elsevier Saunders; 2013. 102:1048–1056.
• [6] Libeer F, Vanhamel N, Huyghe M, Verlinden E. Spontaneous gastric rupture in non-neonatal children: a case report. Acta Chir Belg. 2007;107(5):560–563
• [7] Rygl M, Pýcha K. Perforation of the stomach by a foreign body in a girl with anorexia nervosa: case report. Rozhl Chir. 2002; 81(12):628–630.
• [8] Morrison S., Ngo P., Chiu B. Perforated peptic ulcer in the pediatric population: a case report and literature review. J Pediatr Surg Case Rep. 2013;416–419.
• [9] Baltrünaite J, Trainavicius K. Perforated peptic ulcer in children: diagnosis and treatment. Lithuanian Surgery 2015;14(1):38–45.
• [10] Carol WY, Wong PHY, Chung PKH, Tam K, Wong KY. Laparoscopic versus open operation for perforated peptic ulcer in pediatric patients: a10-year experience. J Pediatr Surg. 2015; 50:2038–2040.
• [11] Koç O, Yildiz FD, Narci A, Sen TA. An unusual cause of gastric perforation in childhood: trichobezoar (Rapunzel syndrome). A case report. Eur. J. Pediatr. 2009; 168(4):495–497.
• [12] Nunn A, Jahn N, Hewes J, Wong C. Gastric perforation in a 16-year-old girl. BMJ. 2017; 357:1859.
• [13] Koplewitz BZ, Daneman A, FracrS, Ein SH, McGuigan MA, Mian M. Gastric perforation attributable to liquid nitrogen ingestion. Pediatrics 2000; 105(1):121–123.
• [14] Grosfeld JL, Molinari F, Chaet M, Engum SA, West KW, Rescorla FJ, Scherer LR 3rd. Gastrointestinal perforation and peritonitis in infants and children: experience with 179 cases over ten years. Surgery 1996; 120:650–655.
• [15] Shorter NA, Liu JY, Mooney DP, Harmon BJ. Indomethacin-associated bowel perforations: a study of possible risk factors. J Pediatr Surg 1999; 34:442–444.
• [16] Miserez M, Barten S, Geboes K, Naulaers G, Devlieger H, Penninckx F. Surgical therapy and histological abnormalities in functional isolated small bowel obstruction and idiopathic gastrointestinal perforation in the very low birth weight infant. World J Surg. 2003; 27:350–355.
• [17] Langell JT, Mulvihill SJ. Gastrointestinal perforation and the acute abdomen. Med Clin N Am. 2008; 92:599–625.
• [18] Awolaran OT. Radiographicsigns of gastrointestinal perforation in children: a pictorial review. Afr J Paediatr Surg. 2015; 12(3):161–166.
• [19] Chey WD, Wong BC. Practice parameters committee of the American College of Gastroenterology. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007; 102(8):1808–25.
• [20] Metzger J, Styger S, Sieber C, Flüec M, Vogelbachd P, Hardera F. Prevalence of Helicobacter pylori infection in peptic ulcer perforations. Swiss Med Wkly. 2001; 131(7-8):99–103.
• [21] Seelig MH, Seelig SK, Behr C, Schönleben K. Comparison between open and laparoscopic technique in the management of perforated gastroduodenal ulcers. J Clin Gastro enterol. 2003; 37(3):226–9.
• [22] Ng EK, Lam YH, Sung JJ, Yung MY, To KF, Chan AC, et al. Eradication of Helicobacter pylori prevents recurrence of ulcer after simple closure of duodenal ulcer perforation: randomized controlled trial. Ann Surg. 2000; 231(2):153–8.
• [23] Sharma AK, Mittal S, Malvi SK. Association of Helicobacter pylori with peptic perforation in Chhattisgarh region of India. Trop Gastroenterol. 2000; 21(1):42–3.
• [24] Chu KM, Kwok KF, Law SY, Tuen HH, Tung PH, Branicki FJ, Wong J. Helicobacter pylori status and endoscopy follow-up of patient shaving a history of perforated duodenal ulcer. Gastrointest Endosc. 1999; 50(1):58–62.
• [25]Amin P, Cheng D. Management of complicated appendicitis in the pediatric population: when Surgery doesn't cut it. Semin Intervent Radiol. 2012; 29(3):231–236.
• [26] Kuhls TL. Appendicitis and pelvic abscess. Feigin and Cherry's Textbook of Pediatric Infectious Diseases. 7th ed. Philadelphia: Elsevier Saunders; 2014. 679–689.
• [27] Blundell S., Campbell A., Patel R., Besarovic S. Valentino’s Syndrome in an adolescent boy with pepticulcer perforation simulating acute appendicitis. J Pediatr Surg Spec. 2015; 9(4):40–42.
• [28] Chen SC, Yen ZS, Wang HP, Lin FY, Hsu CY, Chen WJ. Ultrasonography is superior to plain radiography in the diagnosis of pneumoperitoneum. Br J Surg. 2002; 89:351–4.
• [29] Braccini G, Lamacchia M, Boraschi P, Bertellotti L, Marrucci A, Goletti O, et al. Ultrasound versus plain film in the detection of pneumoperitoneum. Abdom Imaging. 1996; 21:404–412.
• [30] Chen KC. Role of point of care ultrasound in the diagnosis of perforated peptic ulcer. Ultrasound in Medicine&Biology 2017; 43:111–112.
• [31] Cadenas RL, Martí de Gracia M, Saturio Galán N, Pérez Dueñas V, Salvatierra Arrieta L, Garzón Moll G. Use of multi detector computed tomography for locating the site of gastrointestinal tract perforations. Cir Esp.2013; 91:316–323.
• [32] Oguro S, Funabiki T, Hosoda K, Inoue Y, Yamane T, Sato M, et al. 64-Slice multi detector computed tomography evaluation of gastrointestinal tract perforation site: detectability of direct findings in upper and lower GI tract. Eur Radiol. 2010; 20:1396–403.
• [33] Chen CH, Huang HS, Yang CC, Yeh YH. The features of perforated peptic ulcers in conventional computed tomography. Hepatogastroenterology 2001;48:1393–6.
• [34] Solis CV, Chang Y, De Moya MA, GC Velmahos, Fagenholz PJ. Freeair on plain film: do we need a computed tomography too? J Emerg Trauma Shock.2014; 7(1):3–8.
• [35] Thorsen K, Glomsaker TB, vonMeer A, Søreide K, Søreide JA. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg. 2011; 15:1329–35.
• [36] Yu SY, Chiu JH, Loong CC, Wu CW, Lui WY. Diagnostic laparoscopy: indication and benefit. Zhonghua Yi Xue Za Zhi (Taipei).1997; 59(3):158–63.
• [37] Yildiz T, Tilla Ilce H, Ceran C, Ilce Z. Simple patch closure for perforated pepticulcer in children followed by Helicobacter pylori eradication. Pak J Med Sci 2014; 30(3):493–496.