Perforated Prepyloric Ulcer in an Adolescent: A Rare Case Report
Essaidi Zakaria
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
El Azhari Ilias *
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
Tadlaoui Mohamed
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
Bouali Ichraq
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
Fakhiri Nassima
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
Ettaoussi Abdelhak
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
Kamal Khadija
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
Majd Abdessamad
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
Bouali Mounir
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
El Bakouri Abdelillah
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
El Hattabi Khalid
Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco.
*Author to whom correspondence should be addressed.
Abstract
Background: Perforated peptic ulcer is uncommon in children and adolescents, and prepyloric perforation is rarely described in this age group. Early recognition is important because perforation may present with acute abdominal pain and vomiting, symptoms that can resemble other abdominal conditions.
Case Presentation: A 15-year-old male presented with acute epigastric pain and vomiting of approximately 10 hours’ duration. He reported no history of non-steroidal anti-inflammatory drug use, recurrent epigastric pain, or documented Helicobacter pylori infection. He was haemodynamically stable, although abdominal examination revealed generalised guarding. Chest radiography demonstrated bilateral subdiaphragmatic free air, suggesting gastrointestinal perforation. Emergency laparoscopy identified purulent intraperitoneal fluid, fibrinous deposits, and a 5-mm anterior prepyloric perforation. The perforation margins were debrided for histopathological evaluation, and the defect was closed with interrupted polyglactin 910 sutures reinforced by a pedicled omental patch. Peritoneal lavage and subhepatic drainage were performed. Recovery was uncomplicated; oral intake resumed on postoperative day 4, and the patient was discharged on day 5. At one month, he was asymptomatic. Endoscopy performed six weeks after surgery showed complete ulcer healing without stenosis. Histopathology and follow-up biopsies showed no evidence of malignancy or Helicobacter pylori.
Conclusion: This case illustrates the importance of considering perforated peptic ulcer in adolescents with acute abdominal symptoms and peritoneal signs. Timely surgical repair and postoperative evaluation were associated with a favourable outcome in this patient.
Keywords: Perforated peptic ulcer, prepyloric ulcer, adolescent, paediatric surgery, pneumoperitoneum, laparoscopy, omental patch, gastric perforation, endoscopy, histopathology