title: Lethal gastric rupture caused by acute gastric ulcer in a 6-year-old girl.
abstract: Gastric rupture is extremely rare in childhood beyond the neonatal period. We describe a previously healthy 6-year-old girl with a large laceration along the greater curvature on the posterior wall of the stomach. The patient was admitted to a neighboring hospital because of vertigo with 1-day history of intractable vomiting and epigastric pain. Although abdominal distension was noticed during the physical examination, muscular rigidity was not detected on palpation. Laboratory data showed severe hypotonic dehydration and moderate metabolic acidosis with hyperkalemia. She suddenly developed cardiac arrest within an hour after admission. After resuscitation, surgical consultation was obtained. Abdominal X-ray and ultrasound revealed abdominal free air and massive cloudy ascites. At laparotomy, there was a large laceration on the greater curvature of the stomach. Pathology of the gastric wall showed mucosal necrosis while the musculature remained intact consistent with an acute gastric ulcer. Since clinical condition of gastric rupture deteriorates rapidly, early diagnosis and appropriate treatment is essential for good prognosis. One should consider that ulcer formation might cause gastric rupture in childhood.
authors.affiliation: Department of Surgery, National center for child health and development, 2-10-1 Ookura Setagaya-ku, Tokyo, 157-8535, Japan. morikawa-n@ncchd.go.jp
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Morikawa
authors.forename: Toshiro
authors.initials: T
authors.lastname: Honna
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Kuroda
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Kitano
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Fuchimoto
authors.forename: Kan
authors.initials: K
authors.lastname: Terawaki
authors.forename: Keiichiro
authors.initials: K
authors.lastname: Tanaka
authors.forename: Noriko
authors.initials: N
authors.lastname: Kawashima
authors.forename: Seiro
authors.initials: S
authors.lastname: Machigashira
authors.forename: Kentaro
authors.initials: K
authors.lastname: Matsuoka
mesh_terms: D000208:Acute Disease; D002648:Child; D017809:Fatal Outcome; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology; D006323:Heart Arrest / Q000209:etiology; D006801:Humans; D009336:Necrosis; D013275:Stomach Rupture / Q000209:etiology*; D013276:Stomach Ulcer / Q000150:complications*