a clinical analysis of complicated gastroduodenal ulcer in children · 2018. 10. 12. · 22...
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![Page 1: A Clinical Analysis of Complicated Gastroduodenal Ulcer in Children · 2018. 10. 12. · 22 5:o}~l:iI}: Al110 1'l Al11 ~ 2004lJ Vol. 10.No. 1, June 2004 A Clinical Analysis of Complicated](https://reader033.vdocument.in/reader033/viewer/2022060818/60977fedb2468a6c154bcb51/html5/thumbnails/1.jpg)
22 5:o}~l:iI}: Al110 1'l Al11 ~ 2004lJ Vol. 10. No. 1, June 2004
A Clinical Analysis of Complicated Gastroduodenal Ulcer in Children
Kwang-Yong Jung, M.D., Yeon Jun Jeong, M.D., Chan Young Kim, M.D.,
Doo Byun Yang, M.D., Jae-Chun Kim, M.D.
Department of Surgery, Chonbuk National University Medical School
Jeonju, Korea
A total of 30 cases of the peptic ulcer in children, who underwent operations from January
1981 to December 1995 because of complications at Department of the Surgery, Chonbuk National University Medical School, is reviewed. Twenty-three were males (76.7%), 7 females (23.3%) and male was preponderant at 3.3: 1. There were 25 cases (83.3%) age 10 to 15 years,
3 (10.0%) between 2 and 9 years, and 2 (6.7%) below 2. The ulcer was located at duodenum in 27 (90.0%), and at stomach in 3 cases 00.0%). Complications were perforation in 19 cases (63.3%), pyloric obstruction in 9 (30.0%) and bleeding in 2 (6.7%). For perforation, truncal
vagotomy with pyloroplasty was done in 11 cases, truncal vagotomy with hemigastrectomy and gastrojejunostomy in 6, and simple closure in 2 cases. For obstruction, truncal vagotomy with hemigastrectomy and gastrojejunostomy was done in 5, and truncal vagotomy and pylo
roplasty in 3 cases. For bleeding lesions, truncal vagotomy and pyloroplasty was performed in 2 cases. Ten postoperative complications developed in 9 patients; adhesive ileus in 5, recurrence in 2, pneumonia 2, and wound seroma 1 case. One patient developed a primary duo
denal perforation and another a recurrent obstruction. Both of patients had symptoms for more than 3 years and were treated with truncal vagotomy and pyloroplasty for the primary operations. Hospital stay was 11.5 days for the patient with perforated ulcer, 11.0 days for
the patient with pyloric obstruction, and 14.5 days for the child with bleeding. Average hospital period was 11.6 days. To reduce recurrences after operation, extensive procedure such as distal gastrectomy with vagotomy at the first operation should be considered in case
with severe complication or with patients who have been symptomatic for long periods. (J Kor Assoc Pediatr Surg lO(1):22~30), 2004.
Index Words: Peptic ulcer, Surf<ery, Complication, Pediatric
Correspondence: Jae-Chun Kim, MD., Department of Surgery,
Chonbuk National University Medical School, 634-18, Keumamdong, Dukjin-gu, Jeonju 561-721, Korea
Tel: 063) 250-1578, Fax: 063) 271-6197 E-mail: [email protected]
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![Page 2: A Clinical Analysis of Complicated Gastroduodenal Ulcer in Children · 2018. 10. 12. · 22 5:o}~l:iI}: Al110 1'l Al11 ~ 2004lJ Vol. 10.No. 1, June 2004 A Clinical Analysis of Complicated](https://reader033.vdocument.in/reader033/viewer/2022060818/60977fedb2468a6c154bcb51/html5/thumbnails/2.jpg)
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Table 1. Age and Ulcer Complication
Age Perforation
Below 2yr 2 . 9yr 1 10 . 15yr 18
Mean + SO(yr) 14.21 +2.97
Total 19 (63.3 %)
p-O.OOO
Table 2. Duration of Ulcer History before Complication
Duration Perforation
No symptom 8 Within 1m 5 1 m . 1yr 3 Over 1yr 3
Total 19 (63.3 %) p-0.257
No. of case
Obstruction
2 7
11.89+4.26
9 (30.0 %)
No. of case
Obstruction
3
2 4
9 (30.0 %)
Hemorrhage
2
0.88+0.18
2 (6.6 %)
Hemorrhage
2
2 (6.6 %)
Total (%)
2(6.6%) 3 (10.0 %)
25 (83.3 %)
30
Total(%)
13 (43.3 %) 5 (16.7 %) 5 (16.7 %) 7 (23.3 %)
30
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24 ::1::o}9-1-i!} :;(-1110:r:! ~11.:2:. 2004\1
Table 3. Laboratory Findings
Laboratory findings Perforation Obstruction Hemorrhage Total p-value
Hb (g/dl) below 8 1 1 2 4 0.001 8 - 12 3 5 8 over 12 15 3 18
Mean+SD 13.8+3.1 10.8+2.0 5.0+2.8 0.000
Hct (%) below 20 2 0.003 20 - 30 3 4 over 30 18 6 24
Mean+SD 40.5+8.6 32.8+5.5 16.9+7.3 0.001
WBC (/mm') below 10,000 3 8 11 0.002 10,000 - 15,000 6 1 7 over 15,000 10 2 12
Mean+SD 16,110+5739 8394+2035 16,950+354 0.002
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Table 4. Location of Ulcer
Location
Duodenal 1 st Duodenal 2nd Pre-pyloric & antrum
Total
Table 5. Operative Method
Method
Truncal vagotomy + pyloroplasty
Hemigastrectomy + drainage procedure
Simple closure
Total
Perforation
18
19 (63.3 %)
Perforation
11
6
2
19 (63.3 %)
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Obstruction Hemorrhage Total (%)
4 22 (73.3 %) 3 2 5 (16.6 %) 2 3 (10.0 %)
9 (30.0 %) 2 (6.6 %) 30
No. of case
Obstruction Hemorrhage Total (%)
3 2 16
6 12
2
9 (30.0 %) 2 (6.6 %) 30
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26
Table 6. Follow-up Outcome
Case Age'/Sex Operation Height Weight
(percentilet ) (percentilet )
1 321M 176 (80 %) 58 (10 %) 2 241M Hemigastrectomy, 178 (90 %) 57 (20 %) 3 291M gastro-jejunostomy 167 (25 %) 67 (5 %) 4 241M and truncal vagotomy 167 (25 %) 45 (5 %) 5 331M 172 (60 %) 69 (60 %)
Truncal vagotomy 170 (45 %) 60 (45 %)
140' 35' and pyloroplasty
175 (80 %) 62 (25 %)
6 231M 7 131M 8 261M
Simple closure 162 (80 %) 48 (20 %) 164 (90 %) 44 (5 %)
9 27/F 10 33/F
, Follow up age t From Size Korea at Korean Agency for Technology and Standard + Mean value of 13-year-old male: Height 158.8cm, Weight 50Akg
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30
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