A Case of Nonoperative Management of Perforated Duodenal Ulcer in Childhood

Abstract

We report a case of nonoperative management of perforated duodenal ulcer in childhood. A 14-year-old male was transported to a hospital by ambulance for abdominal pain. He showed a temperature of 37.5°C, epigastric abdominal pain, and localized muscular defenses. On examination, intraabdominal free air was observed on computed tomography and X-ray images. We diagnosed him as having a perforated duodenal ulcer. The patient’s general condition was good; therefore, we followed nonoperative management in accordance with the Evidence-based Clinical Practice Guidelines for Peptic Ulcer 2015 published by The Japanese Society of Gastroenterology. Conservative therapy included fasting and administration of drips, antibiotics, and antiulcer drugs. The patient’s temperature and abdominal pain improved on day 2. Oral intake resumed on day 5, and he was discharged on day 8. Because Helicobacter pylori (H. pylori)-immunoglobulin G antibody remained above the normal level, we suspected that the cause of duodenal ulcer was an H. pylori infection. Upper endoscopy showed scarring of the perforated duodenal ulcer of the bulbus. We performed eradication therapy for H. pylori and observed the boy on an outpatient basis. The duodenal ulcer did not recur. Given the outcome of this case, we think that the nonoperative management of perforated duodenal ulcer is a suitable treatment option for pediatric patients.