Gastro‐Duodenal Ulcer in Childhood

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Abstract
Summary.: The writer reports the case histories of 2 girls, aged 9 and 11 respectively. The younger girl had been suffering from periodic vomiting for 5 years, whereas the other patient had suffered from vomiting for 2 years as well as periodic, partly tardy pain in the epigastric region and exhibited melsena twice. In both patients Ewald's test meal was of a large quantity and X‐ray examination revealed a typical duodenal ulcer.Ulcerations of the stomach and duodenum are most frequently encountered in the first year of life and around puberty. In infancy the ulcers nearly always have appeared in conjunction with infections, intoxications, traumata, circulatory disorders, burns, or cachexia, but the ulcers occurring in children above 5 years of age in the vast majority of cases are based on actual gastroduodenitis.The disease may manifest itself by (a) a gastroduodenitic syndrome just as in adults, (b) the sudden occurrence of complications (haemorrhage or perforation) and finally, presumably most often by (c) vague and uncharacteristic symptoms.Mention is made of complications and differential diagnosis. The treatment should be conservative, considering that the operation most in use for the moment (resection), which presumably is the only rational surgical treatment, entails a high primary mortality apart from being apt to cause lasting disorders. Operation is called for only in cases of severe stenosis and perforation.In the conclusion the writer emphasizes that gastro‐duodenal ulcers in childhood presumably occur more frequently than is generally supposed and that a more extensive use of X‐ray in the examination of children with uncharacteristic dyspeptic symptoms no doubt would lead to a recognition of ulcer more frequently than the procedures used at the present moment.

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