ISSN - 0973-0958
   
 
Spontaneous Pre-pyloric Perforation in Children
Kaushal Kulkarni, Charu Tiwari, Nilesh Nagdeve, Rajendra Saoji.
Department of Pediatric Surgery, Government Medical College and Hospital, Nagpur, Maharashtra, India.
 
Abstract

Background: Gastro-intestinal (GI) perforation is less common in pediatric age-group. Spontaneous pre-pyloric/gastric perforation is rarer. We present 7 cases of spontaneous pre-pyloric perforation.
Materials and Methods: All patients under 18 years of age operated for spontaneous pre-pyloric perforation were included in the study and were analyzed with respect to age at presentation, gender, clinical presentation, management, post-operative recovery, and follow-up. All patients were admitted, and detailed history and vitals were recorded. After confirming the diagnosis on erect X-ray abdomen, they were either taken for exploratory laparotomy if stable or initial external peritoneal drainage followed by exploration in unstable patients.
Results: There were total seven patients with spontaneous pre-pyloric perforation. The mean age at presentation was 4.5 years. There were 5 males and 2 females. The mean duration of symptoms was 3 days. There were three neonates-two were pre-term and low birth weight and underwent initial peritoneal drainage followed by exploration after stabilization. The third neonate was full-term, adequate for gestational age and had associated Tetralogy of Fallot. There were two pre-school children, one school-going child, and an adolescent. At exploration, all had a pre-pyloric perforation which was primarily repaired with omental patch. All patients except one neonate were discharged by 7-10 days. One neonate died within a month of discharge from the hospital.
Conclusion: Though rare, spontaneous pre-pyloric perforation in a pediatric age group may carry high morbidity and mortality. Exploration after stabilization remains the treatment of choice.
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