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

J Pediatr Surg. 2005 May;40(5):850-4. doi: 10.1016/j.jpedsurg.2005.01.056.

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.

MeSH terms

  • 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
  • Gastric Outlet Obstruction / surgery
  • Histamine H2 Antagonists / therapeutic use*
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Peptic Ulcer / chemically induced
  • Peptic Ulcer / complications
  • Peptic Ulcer / drug therapy
  • Peptic Ulcer / mortality
  • Peptic Ulcer / 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

Substances

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