A Clinical Analysis of Complicated Gastroduodenal Ulcer in Children

(1)

A Clinical Analysis of Complicated Gastroduodenal Ulcer in Children

Kwang-Yong Jung, M.D., Yeon Jun Jeong, M.D., Chan Young Kim, M.D., Doo Byun Yang, M.D., Jae-Chun Kim, M.D.

Department of Surgery, Chonbuk National University Medical School Jeonju, Korea

A total of 30 cases of the peptic ulcer in children, who underwent operations from January 1981 to December 1995 because of complications at Department of the Surgery, Chonbuk National University Medical School, is reviewed. Twenty-three were males (76.7%), 7 females (23.3%) and male was preponderant at 3.3: 1. There were 25 cases (83.3%) age 10 to 15 years, 3 (10.0%) between 2 and 9 years, and 2 (6.7%) below 2. The ulcer was located at duodenum in 27 (90.0%), and at stomach in 3 cases 00.0%). Complications were perforation in 19 cases (63.3%), pyloric obstruction in 9 (30.0%) and bleeding in 2 (6.7%). For perforation, truncal vagotomy with pyloroplasty was done in 11 cases, truncal vagotomy with hemigastrectomy and gastrojejunostomy in 6, and simple closure in 2 cases. For obstruction, truncal vagotomy with hemigastrectomy and gastrojejunostomy was done in 5, and truncal vagotomy and pylo- roplasty in 3 cases. For bleeding lesions, truncal vagotomy and pyloroplasty was performed in 2 cases. Ten postoperative complications developed in 9 patients; adhesive ileus in 5, re- currence in 2, pneumonia 2, and wound seroma 1 case. One patient developed a primary duo- denal perforation and another a recurrent obstruction. Both of patients had symptoms for more than 3 years and were treated with truncal vagotomy and pyloroplasty for the primary operations. Hospital stay was 11.5 days for the patient with perforated ulcer, 11.0 days for the patient with pyloric obstruction, and 14.5 days for the child with bleeding. Average hospital period was 11.6 days. To reduce recurrences after operation, extensive procedure such as distal gastrectomy with vagotomy at the first operation should be considered in case with severe complication or with patients who have been symptomatic for long periods.

(J

Kor Assoc Pediatr Surg

lO(1):22~30),

2004.

Index Words: Peptic ulcer, Surf<ery, Complication, Pediatric

Correspondence: Jae-Chun Kim, MD., Department of Surgery, Chonbuk National University Medical School, 634-18, Keumam- dong, Dukjin-gu, Jeonju 561-721, Korea

Tel: 063) 250-1578, Fax: 063) 271-6197 E-mail: [email protected]

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Table 1. Age and Ulcer Complication

Age Perforation

Below 2yr

2 . 9yr 1

10 . 15yr 18

Mean + SO(yr) 14.21 +2.97

Total 19 (63.3 %)

p-O.OOO

Table 2. Duration of Ulcer History before Complication Duration

Perforation

No symptom 8

Within 1m 5

1 m . 1yr 3

Over 1yr 3

Total 19 (63.3 %)

p-0.257

No. of case Obstruction

2 7 11.89+4.26

9 (30.0 %)

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Total (%) 2(6.6%) 3 (10.0 %) 25 (83.3 %)

30

Total(%) 13 (43.3 %)

5 (16.7 %) 5 (16.7 %) 7 (23.3 %)

30

(3)

Table 3. Laboratory Findings

Laboratory findings Perforation Obstruction Hemorrhage Total p-value

Hb (g/dl)

below 8 1 1 2 4 0.001

8 - 12 3 5 8

over 12 15 3 18

Mean+SD 13.8+3.1 10.8+2.0 5.0+2.8 0.000

Hct (%)

below 20 2 0.003

20 - 30 3 4

over 30 18 6 24

Mean+SD 40.5+8.6 32.8+5.5 16.9+7.3 0.001

WBC (/mm')

below 10,000 3 8 11 0.002

10,000 - 15,000 6 1 7

over 15,000 10 2 12

Mean+SD 16,110+5739 8394+2035 16,950+354 0.002

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Table 4. Location of Ulcer

Location

Duodenal 1 st Duodenal 2nd Pre-pyloric & antrum

Total

Table 5. Operative Method Method

Truncal vagotomy

+ pyloroplasty

Hemigastrectomy

+ drainage procedure Simple closure

Total

Perforation

18 19 (63.3

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Perforation

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19 (63.3

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Table 6. Follow-up Outcome

Case Age'/Sex Operation Height Weight

(percentilet ) (percentilet )

1

321M 176 (80 %) 58 (10 %)

2 241M Hemigastrectomy, 178 (90 %) 57 (20 %)

3 291M gastro-jejunostomy 167 (25 %) 67 (5 %)

4 241M and truncal vagotomy 167 (25 %) 45 (5 %)

5 331M 172 (60 %) 69 (60 %)

Truncal vagotomy 170 (45 %) 60 (45 %)

140' 35'

and pyloroplasty

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6 231M

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8

261M

Simple closure 162 (80 %) 48 (20 %)

164 (90 %) 44 (5 %)

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10 33/F

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