Surgery for peptic ulcer disease in children in the post-histamine2-blocker era.
OBJECTIVE
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-histamine 2 -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.
Edwards
Mary J
MJ
Division of Pediatric Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Kollenberg
Sarah J
SJ
Brandt
Mary L
ML
Wesson
David E
DE
Nuchtern
Jed G
JG
Minifee
Paul K
PK
Cass
Darrell L
DL
D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D015897:Comorbidity; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000379:methods; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery; D006635:Histamine H2 Antagonists / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010437:Peptic Ulcer / Q000139:chemically induced / Q000150:complications / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D010438:Peptic Ulcer Hemorrhage / Q000601:surgery; D010439:Peptic Ulcer Perforation / Q000601:surgery; D010538:Peritonitis / Q000209:etiology; D011027:Pneumoperitoneum / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D011706:Pyloric Antrum / Q000601:surgery; D011708:Pylorus / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome; D014628:Vagotomy
D000305:Adrenal Cortex Hormones; D000894:Anti-Inflammatory Agents, Non-Steroidal; D006635:Histamine H2 Antagonists