Clinical course and management of pediatric gastroduodenal perforation beyond neonatal period

Naohiro Takamoto; Takaaki Konishi; Michimasa Fujiogi; Mai Kutsukake; Kaori Morita; Yohei Hashimoto; Hiroki Matsui; Kiyohide Fushimi; Hideo Yasunaga; Jun Fujishiro

doi:10.1016/j.pedneo.2024.06.014

Clinical course and management of pediatric gastroduodenal perforation beyond neonatal period

Pediatr Neonatol. 2024 Dec 16:S1875-9572(24)00206-7. doi: 10.1016/j.pedneo.2024.06.014. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Japan; Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
² Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan.
³ Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Japan; Division of Surgery, Department of Surgical Specialties, National Center for Child Health and Development, Japan.
⁴ Save Sight Institute, The University of Sydney, Australia.
⁵ Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Japan.
⁶ Department of Pediatric Surgery, Graduate School of Medicine, The University of Tokyo, Japan. Electronic address: jfujishi-tky@umin.ac.jp.

PMID: 39709268
DOI: 10.1016/j.pedneo.2024.06.014

Abstract

Background: The treatments and outcomes of pediatric gastroduodenal perforations have rarely been described.

Methods: We retrospectively identified 515 patients aged 28 days to 17 years who were hospitalized for gastroduodenal perforation between July 2010 and March 2021 using a nationwide inpatient database. We compared characteristics, treatments, and outcomes for pediatric gastroduodenal perforation between children aged <7 years (n = 38) and ≥7 years (n = 477).

Results: Children aged <7 years had a higher prevalence of females, comorbidities, and gastric perforation than those aged ≥7 years. Compared to children aged ≥7 years, children aged <7 years were more likely to receive surgical treatment (79% vs. 55%), open surgery (58% vs. 19%), and supportive treatment such as mechanical ventilation (39% vs. 2.5%), treatment for disseminated intravascular coagulation (13% vs. 1.3%), catecholamines (32% vs. 2.7%), blood transfusion (37% vs. 2.1%), and intensive care unit admission (47% vs. 7.1%). Children aged <7 years had higher in-hospital mortality (5.3% vs. 0.4%) and morbidity (18% vs. 4.8%) than those aged ≥7 years.

Conclusions: In pediatric gastroduodenal perforation, children aged <7 years were more likely to have comorbidities, undergo surgical and supportive treatments, and demonstrate poor outcomes than those aged ≥7 years.

Keywords: Gastroduodenal perforation; Non-operative management; Operative management; Pediatric; Surgery.