Background/Purpose: The aim of this study was to determine the presentation, treatment, and outcome of children requiring surgery for peptic ulcer disease (PUD) in the post-histamine2-blocker era. Methods: The charts ...Background/Purpose: The aim of this study was to determine the presentation, treatment, and outcome of children requiring surgery for peptic ulcer disease (PUD) in the post-histamine2-blocker era. Methods: The charts of all children undergoing surgery for PUD in our institution since 1980 were retrospectively reviewed. Data were collected regarding clinical presentation, operative details, postoperative course, and outcome. Results: Twenty-nine children (7.2 ±7.5 years) required surgery for complications of PUD. Indications for operation were bleeding (n = 11), pneumoperitoneum(n = 13), peritonitis (n = 3), and gastric outlet obstruction refractory to medical therapy (n = 2). For those children with bleeding, 8 had simple oversew of the bleeding ulcer(s), 2 had oversew with vagotomy and pyloroplasty, and 1 required vagotomy and antrectomy. All patients with perforation (n = 16) were treated with simple closure with or without omental patch. One child with gastric outlet obstruction underwent vagotomy and antrectomy and 1 had vagotomy and pyloroplasty. Preoperative risk factors or comorbidities were present in 27 of 29 patients and included steroid or nonsteroidal antiinflammatory drug medications in 13 children (only 3 of whom were receiving antiulcer prophylaxis). Postoperative complications occurred in 11 of 29 patients. Three (10%) children required reoperation for persistent or recurrent ulcer disease and 4 children died. Conclusions: PUD remains a highly morbid and mortal condition in children despite the availability of effective acid-reducing medications. Effective prophylaxis of children receiving steroids and nonsteroidal antiinflammatory drugs may play a role in decreasing the risk of PUD.展开更多
大多数消化性溃疡是由于幽门螺杆菌(Helicobacter pylori,Hp)的慢性感染所致,抗生素治疗通常能够同时抗 Hp 和治愈溃疡病。然而,在过去几十年里,顽固性溃疡病常需要外科治疗,包括迷走神经切断术和胃部分切除术,前者仅缓解症状,后者既切...大多数消化性溃疡是由于幽门螺杆菌(Helicobacter pylori,Hp)的慢性感染所致,抗生素治疗通常能够同时抗 Hp 和治愈溃疡病。然而,在过去几十年里,顽固性溃疡病常需要外科治疗,包括迷走神经切断术和胃部分切除术,前者仅缓解症状,后者既切除了溃疡也切除了 Hp 的感染部位。展开更多
文摘Background/Purpose: The aim of this study was to determine the presentation, treatment, and outcome of children requiring surgery for peptic ulcer disease (PUD) in the post-histamine2-blocker era. Methods: The charts of all children undergoing surgery for PUD in our institution since 1980 were retrospectively reviewed. Data were collected regarding clinical presentation, operative details, postoperative course, and outcome. Results: Twenty-nine children (7.2 ±7.5 years) required surgery for complications of PUD. Indications for operation were bleeding (n = 11), pneumoperitoneum(n = 13), peritonitis (n = 3), and gastric outlet obstruction refractory to medical therapy (n = 2). For those children with bleeding, 8 had simple oversew of the bleeding ulcer(s), 2 had oversew with vagotomy and pyloroplasty, and 1 required vagotomy and antrectomy. All patients with perforation (n = 16) were treated with simple closure with or without omental patch. One child with gastric outlet obstruction underwent vagotomy and antrectomy and 1 had vagotomy and pyloroplasty. Preoperative risk factors or comorbidities were present in 27 of 29 patients and included steroid or nonsteroidal antiinflammatory drug medications in 13 children (only 3 of whom were receiving antiulcer prophylaxis). Postoperative complications occurred in 11 of 29 patients. Three (10%) children required reoperation for persistent or recurrent ulcer disease and 4 children died. Conclusions: PUD remains a highly morbid and mortal condition in children despite the availability of effective acid-reducing medications. Effective prophylaxis of children receiving steroids and nonsteroidal antiinflammatory drugs may play a role in decreasing the risk of PUD.
