Perforated Stress Ulcer in Infants

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Abstract
Stress ulcer has become an important clinical entity and its 2 major complications, bleeding and perforation, are among the most baffling problems, in terms of management, in clinical practice. Perforation, though the less common of the two, is perhaps the most formidable particularly when this occurs in a very sick infant. Four such infants (cyanotic heart disease, gastroenteritis and 2 severe pneumonias) all developed this severe complication of their illness and after surgery 2 survived. Two of these infants presented with bleeding prior to perforation of their stress ulcer. The perforation diagnosis was initially not apparent and was 1st made after radiological examination. Clinical signs of peritonitis were absent as these infants were too sick for such signs to be elicited. All 4 ulcers were situated in the posterior wall of the duodenum. Of these infants, 2 developed cardiac complications on the operating table, the cause of which was not very clear. It may have been due to the debilitation of these babies with the additional effect of anesthesia perhaps leading to myocardial toxicity. All sick infants on steroid therapy should be placed on prophylactic antacids; abdominal girth measurements should be taken frequently in sick infants to appreciate any unexplained increase in girth: such increase in abdominal girth must be evaluated with an upright abdominal X-ray and operative closure of the perforation must be simple and expedient.