Indian Pediatrics - Editorial

Letters to the Editor

Indian Pediatrics 2003; 40:272

Duodenal Ulcer in Childhood in Developing Countries

I read with interest the report by Mohta et al.(1) on perforated doudenal ulcer in childhood. Peptic ulcer disease is not common in children and rarely suspected as a cause of abdominal complaints in this age group. Diagnosis is therefore made only when they develop complications, particularly in developing countries. Vague or unexplained abdominal pain or vomiting which may be the early symptoms are also the symptoms of parasitic infestation, malaria and gastro-intestinal infections, common problems in developing countries. These conditions are therefore more commonly suspected and little thought is given to peptic ulcer disease. This is compounded by the fact that upper gastro-intestinal endoscopy which is a useful diagnostic tool in peptic ulcer disease is not readily available in many hospitals in less developed countries.

In our experience in Zaria, Nigeria(2), six children aged 7-15 years had surgical treatment for dodenal ulcer in the 10 year period (1987-1996). Four of them had complications (pyloric stenosis 2, perforation 1, hemorrhage 1) and 2 were uncomplicated. As Mohta et al.(1) noted, children usually present when complications have occurred. Though in developed countries perforation and bleeding are the common complica-tions(3), in Zaria(2) and another report from India(4), pyloric stenosis is more common, perhaps due to delayed diagnosis and chronicity.

Peritonitis in children in developing countries, though most commonly due to typhoid perforation and perforated appendi-citis, may be due to perforated doudenal ulcer(1,2). Due to lack of suspicion, diagnosis is usually made at laparotomy. We prefer a simple closure and omental patch. However, in the fit child without much peritoneal contamination, truncal vagotomy and drain-age can be performed if the surgeon has the experience to perform the operation. It is important for those caring for children in developing countries to have a high index of suspicion for peptic ulcer in children with recurrent abdominal pain so that early diagnosis can be made, and complications are avoided.

Emmanuel A. Ameh,
Senior Lecturer and
Consultant Pediatric Surgeon,
Ahmadu Bello University and Ahmadu Bello
University Teaching Hospital,
P.O. Box 76, Zaria 810 001, Nigeria.
E-mail: [email protected]

References

1. Mohta A, Shrivastava UK, Gupta BP, Gupta A. Perforated duodenal ulcer in a child. Indian Pediatr 2002; 39: 578-579.

2. Ameh EA. Peptic ulcer disease in childhood in Zaria, Nigeria. Ann Trop Pediatr 1999; 19: 65-68.

3. Gryboski JD. Peptic ulcer disease in children. Med Clin North Am 1991; 75: 889-902.

4. Gahukamble DB, Fenn AS, Devadata J, Mammen KE. Duodenal ulcer in South Indian children. Ann Surg 1983; 145: 322-324.