A Rare Cause of Acute Abdominal Pain in Childhood: Peptic Ulcer Perforation

Peptic ulcer disease (PUD), which may be complicated by severe hemorrhage or perforation, is a rare cause of lifethreatening abdominal pain in children. Perforation is the second most common complication of PUD following acute gastrointestinal hemorrhage (1,2). The disease is characterized by a loss of tissue penetrating gastrointestinal mucosa. Although the exact etiology of peptic ulcer perforation still remains unclear, some factors such as stress, an underlying disease or corticosteroid/non-steroidal anti-inflammatory drugs are proven to play a role (2,3). Peptic ulcers are often localized in the anterior wall of the duodenum. The gold standard of diagnosis is endoscopy. In case of perforation, there is a free air under the diaphragm diagnostic and another radiologic examination is not required (3,4). However, an absence of free air under the diaphragm does not rule out the diagnosis of perforation (4). The aim of this case series is to emphasize that gastrointestinal perforation should be considered in the differential diagnosis in children (especially adolescents) presenting with acute abdominal pain even in the absence of dyspeptic symptoms. Four children (2 girls, 2 boys) with a mean age of 12 years (3-16 years) who presented with peptic ulcer perforation (PUP) were included in this study. Three had perforated duodenales and one had a perforated gastric ulcer. The characteristics of the patients are presented in Table I. Informed consent was given by all parties involved.