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]