Abstract
A 14-year-old boy from a remote locality of Palpa district, Nepal, presented to the emergency room with chief complaints of pain in the upper central abdomen for three hours associated with one episode of non-bilious vomiting. In view of raised neutrophil count and pneumoperitoneum on chest x-ray, a diagnosis of peptic ulcer perforation was reached. On exploratory laparotomy, a perforation of about 0.4x0.4 cm at the prepyloric region, near the lesser curvature of the stomach, was noted with flakes on stomach surface and small intestine. Minimal dirty fluid was present in the Morrison’s pouch. Peritoneal lavage followed by primary repair of the perforation was performed by applying modified Grahm’s patch technique. The postoperative period was uneventful, and subsequently the patient was discharged on the seventh postoperative day. Poorly understood mechanisms behind pediatric peptic ulcer perforations suggest possible roles for idiopathic ulceration, congenital muscular defects, ischemia, or stress-related mucosal injury.
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