Among the complications that are observed in children less often than in adults (in about 10% of cases), ulcer bleeding, perforation and stenosis of the pyloroduodenal zone should be mentioned . Bleeding can be minor, detectable only when examining feces for occult blood, and massive, manifested by bloody vomiting, tarry stools. Massive bleeding is accompanied by general weakness, dizziness, tachycardia, a decrease in blood pressure, a subsequent decrease in blood hemoglobin and the number of red blood cells. Perforation of an ulcer with the development of acute peritonitis is usually accompanied by rather vivid symptoms: acute “dagger” pain in the epigastric region, muscle protection of the abdominal wall, etc. Analysis of anamnestic data allows us to reject the widespread opinion that the disease course is not symptomatic in the period preceding ulcer perforation. This applies equally to the perforations that occur during treatment with glycocorticoids , which once again indicates the importance of targeted interrogation before their appointment for various diseases in children. In the initial period of stenosis of the pyloroduodenal zone, especially persistent pain is observed, occasionally profuse vomiting, belching “rotten” even with high active acidity of gastric juice. Subsequently, vomiting becomes more frequent, appetite decreases, progressive emaciation develops, constantly, even on an empty stomach, the fluid in the distended stomach is determined. In such cases, only timely surgical treatment can save the life of the child. Despite the good direct result of treatment obtained in almost all patients, it is impossible to consider the course and outcome of peptic ulcer in children as favorable; according to some researchers, exacerbations and relapses requiring re-hospitalization occur in almost every fourth child.
Differential diagnosis of peptic ulcer of the stomach and duodenum
. Many researchers believe that peptic ulcer and usually concomitant, and often preceding, gastroduodenitis (gastritis) are pathogenetically uniform, therefore, the differentiation of these diseases is of considerable complexity. It should be borne in mind that with peptic ulcer, pain in the epigastric region is more intense, more often there is “hungry” and nocturnal, a more pronounced tendency to seasonal exacerbations, higher basal secretion, more frequent nausea and vomiting, and there may be hidden bleeding. In the absence of x-ray confirmation in patients with clinical and laboratory research and observation data typical of the ulcer process, they diagnose chronic gastroduodenitis, suggest a pre-ulcerated condition and prescribe the same treatment as for peptic ulcer disease.
Pain in the epigastric region with hepatocholecystitis is usually not associated with food intake, is not “hungry” and does not subside after eating. Exacerbations of the disease do not bear a clear connection with the season of the year; there is no family predisposition to diseases of the stomach.
A thorough analysis of the anamnesis, clinical and laboratory data and, especially, X-ray examination allows for differential diagnosis with processes such as diverticula of the segments of the alimentary canal, chronic colitis, pancreatitis, etc.