Laparoscopic Repair of A Perforated Duodenal Ulcer in a 5-Year Old Patient
Ulcer disease in children, though not common, is increasing in incidence. This is in contrast to the decreasing incidence in the adult population. Usually kids present with pain or bleeding. Perforated ulcers are very rare in this age group but their treatment is similar to that of adults.  After surgery, children stay on proton pump inhibitors for 6 months & have follow up endoscopy. 


Decubitus X-Ray - Figure 1

A 5-year old boy with an 8-day history of vomiting & intermittent fever.  He responded to supportive care at home & tolerated liquids fairly well.   On the day prior to going to the ER, the boy began to complain of abdominal pain.  A CT scan was completed but no sign of any problems found.  After being transferred to the children’s hospital, the child appeared to have an acute surgical abdomen.  Plan decubitus x-rays showed free air in the abdominal cavity (fig. 1). 


Clinical Photograph of the Ulcer at Presentation - Figure 2

The boy was taken to the operating room & laparoscopic evaluation demonstrated a perforated post pyloric channel ulcer (fig. 2). 
Repair & Graham patch (omental patch). The repair was completed laparoscopically with three 5mm working ports.   

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