WOFAPS 2025 8th World Congress of Pediatric Surgery

Sara Mohammad Amin, Naima Zamir

national Institute of Child Health

Title:

“Intraoperative and postoperative management of duodenal perforations in children: a descriptive case series.”

Author: Sara Muhammad Amin, Paediatric Surgery Resident

Co Author: Naima Zamir, Professor Paediatric Surgery

Purpose:

To investigate the intraoperative determinants guiding the surgical management of paediatric duodenal perforations—considering factors such as timing of presentation, defect characteristics, and peritoneal contamination—and to evaluate postoperative morbidity and the effectiveness of conservative management in selected cases

Method:

The study was conducted in the Department of PaediatricSurgery from January 2022 to October 2024, following approval by the Institutional Ethical Review Board (IERB). A total of ten cases of duodenal perforation, confirmed intraoperatively during laparotomy, were included. Surgical management was guided by intraoperative assessment, with procedures including primary closure, repair over a T-tube, or repair with placement of a trans-anastomotic tube. Postoperative care focused on nutritional rehabilitation, fluid and electrolyte balance, and the management of sepsis.

Results:

Ten paediatric patients with duodenal perforation (Five traumatic, five non-traumatic) were managed case-by-case, guided by intraoperative findings such as level of perforation and extent of abdominal contamination. Surgical techniques included primary repair, T-tube, or trans anastomotic tube placement. Complications occurred in 4 patients (40%), primarily enterocutaneous fistulas and anastomotic leaks. Most were managed conservatively with early enteral feeding, electrolyte correction, and infection control, avoiding re-exploration. Non-traumatic cases had higher morbidity and longer hospital stays (up to fifty-eight days), while early presentation was associated with better outcomes

Conclusion:

The surgical approach to paediatric duodenal perforations should be guided primarily by intraoperative findings rather than the underlying aetiology. While surgical intervention is essential, favorable outcomes are largely dependent on meticulous postoperative care. Early initiation of enteral nutrition, along with effective sepsis management, enables conservative resolution of most complications, thereby minimizing the need for re-exploration or additional surgical procedures