WOFAPS 2025 8th World Congress of Pediatric Surgery

Malek Mezni, Yosra Ben Ahmed, wiem Hamouda, Mariem Marzouki, Faouzi Nouira, Said Jlidi

Children Hospital Bechir Hamza, Pediatric surgery department B. Tunis, Tunisia

Background
Gastric ulcer is a rare condition in the pediatric population, and its perforation is even more uncommon. It often mimics other causes of acute abdomen, which can delay diagnosis. Here, we report two cases of gastric perforation in previously healthy adolescents, each presenting with different clinical features but sharing the same underlying pathology.

Case Presentations
Case 1: A 13-year-old boy presented with acute epigastric pain and vomiting, following a one-month history of ulcer-like symptoms. He was hemodynamically stable with localized epigastric tenderness. Chest X-ray revealed bilateral pneumoperitoneum. Diagnostic laparoscopy revealed a 0.5 cm prepyloric anterior perforation, which was sutured after biopsy. The postoperative course was uneventful. The patient was discharged under Helicobacter pylori eradication therapy.

Case 2: Another 13-year-old boy presented with generalized abdominal pain, vomiting, and signs of hypovolemic shock. On examination, he had diffuse peritonitis. Abdominal radiography showed free air. After resuscitation, laparoscopy revealed purulent peritonitis without an evident source. Conversion to laparotomy identified a small perforation on the greater curvature of the stomach. The ulcer was sutured and biopsied. The patient recovered well and was discharged on quadruple anti-H. pylori therapy. Histopathological analysis confirmed ulceration in both cases.

Conclusion
Gastric ulcer perforation in adolescents may present different clinical features with variable severity. While rare, it should be considered in the differential diagnosis of acute abdomen. Prompt imaging, surgical management, and targeted medical treatment are key to achieving favorable outcomes.