Surgery for peptic ulcer disease in children in the post-histamine2-blocker era.

Abstract

BACKGROUND/PURPOSE:

The aim of this study was to determine the presentation, treatment, and outcome of children requiring surgery for peptic ulcer disease (PUD) in the post-histamine 2 -blocker era.

METHODS:

The charts of all children undergoing surgery for PUD in our institution since 1980 were retrospectively reviewed. Data were collected regarding clinical presentation, operative details, postoperative course, and outcome.

RESULTS:

Twenty-nine children (7.2 +/- 7.5 years) required surgery for complications of PUD. Indications for operation were bleeding (n = 11), pneumoperitoneum (n = 13), peritonitis (n = 3), and gastric outlet obstruction refractory to medical therapy (n = 2). For those children with bleeding, 8 had simple oversew of the bleeding ulcer(s), 2 had oversew with vagotomy and pyloroplasty, and 1 required vagotomy and antrectomy. All patients with perforation (n = 16) were treated with simple closure with or without omental patch. One child with gastric outlet obstruction underwent vagotomy and antrectomy and 1 had vagotomy and pyloroplasty. Preoperative risk factors or comorbidities were present in 27 of 29 patients and included steroid or nonsteroidal antiinflammatory drug medications in 13 children (only 3 of whom were receiving antiulcer prophylaxis). Postoperative complications occurred in 11 of 29 patients. Three (10%) children required reoperation for persistent or recurrent ulcer disease and 4 children died.

CONCLUSIONS:

PUD remains a highly morbid and mortal condition in children despite the availability of effective acid-reducing medications. Effective prophylaxis of children receiving steroids and nonsteroidal antiinflammatory drugs may play a role in decreasing the risk of PUD.

• Authors: Mary J Edwards, Sarah J Kollenberg, Mary L Brandt, David E Wesson, Jed G Nuchtern, Paul K Minifee, Darrell L Cass
• Journal: Journal of pediatric surgery (J Pediatr Surg) Vol. 40 Issue 5 Pg. 850-4 (May 2005) ISSN: 1531-5037 [Electronic] United States
• PMID: 15937829 (Publication Type: Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Anti-Inflammatory Agents, Non-Steroidal
• Histamine H2 Antagonists

Topics

• Adolescent
• Adrenal Cortex Hormones (adverse effects)
• Adult
• Anti-Inflammatory Agents, Non-Steroidal (adverse effects)
• Child
• Child, Preschool
• Combined Modality Therapy
• Comorbidity
• Databases, Factual
• Elective Surgical Procedures (statistics & numerical data)
• Female
• Follow-Up Studies
• Gastrectomy (methods)
• Gastric Outlet Obstruction (etiology, surgery)
• Histamine H2 Antagonists (therapeutic use)
• Humans
• Infant
• Infant, Newborn
• Male
• Peptic Ulcer (chemically induced, complications, drug therapy, mortality, surgery)
• Peptic Ulcer Hemorrhage (surgery)
• Peptic Ulcer Perforation (surgery)
• Peritonitis (etiology)
• Pneumoperitoneum (etiology)
• Postoperative Complications (epidemiology)
• Pyloric Antrum (surgery)
• Pylorus (surgery)
• Reoperation
• Retrospective Studies
• Treatment Outcome
• Vagotomy