Журнал «Здоровье ребенка» 8 (51) 2013

Introduction. The important section of surgical gastroenterology of children’s age are complications of stomach ulcer of a stomach and a duodenal gut [1, 2]. Growth of frequency of stomach ulcer at children induces domestic and foreign researchers to studying of features of a clinical course of a disease, pathogenetic mechanisms of its development, development of new methods of its diagnostics and treatment [2–4].

The most terrible complications of stomach ulcer of a stomach and duodenal gut are gastro-duodenal bleedings and perforation. If bleedings meet frequency of 8–22 %, perforation at these diseases is observed rather less often [1, 2, 5–7]. It defines brief personal experience of each of clinical physicians in questions of diagnostics and surgical treatment of a disease and leads to emergence of difficulties of rather early diagnostics and a choice of adequate surgical tactics in each case.

Research objective: the analysis of features of a clinical current and diagnostics of perforative stomach and duodenal ulcers at children.

Material and research methods. 52 patients aged from 14 till 17 years with perforative stomach and duodenal ulcer are subjected to the analysis. Girls there were 9 (17 %), boys — 43 (83 %). Perforation duodenum was observed at 38 (73 %) children, perforative stomach ulcers are noted at 14 (28 %) patients. To all children in an emergency order surgeries laparoscopic and opened were made in the ways.

Results of research. Perforative ulcers prevailed at boys in the ratio about 5 : 1, and perforation duodenum prevailed over perforative stomach ulcers by 2.5 times that will be coordinated with literature data concerning the frequency of occurrence of stomach ulcer at children. All patients were hospitalized in surgical offices in an emergency order. The average prescription of a disease for all patients made 7.5 ± 1.4 hours. 37 (72 %) children are operated within the first 2 hours after receipt in a hospital, 15 (28 %) the patient surgeries were made within 12 hours after hospitalization.

The diagnosis of perforative stomach ulcer and duodenal gut was based on use of the comprehensive diagnostic program including stage-by-stage use of diagnostic actions taking into account their resolution in each case.

The most reliable and typical signs of approach of perforation were: the sudden beginning in the form of sharp pain in the top departments with fast subsequent distribution on all stomach, which are noted at 33 (82.4 %) patients, tension of muscles of a forward belly wall was observed in 67.1 % of cases, the general serious condition of the patient owing to painful shock and intoxication took place at 22.5 % of patients. At 23 % of patients of manifestation of perforation were characterized by the gradual beginning, thus pains in the top departments of a stomach abated, at a palpation morbidity in the right half of a stomach was defined, there was no tension of muscles of a forward belly wall, doubtful symptoms of irritation of a peritoneum were noted.

Conclusions. 1. Perforative stomach and duodenal ulcers at children arise suddenly, are characterized by manifest clinic of sharp peritonitis and absence in the anamnesis of ulcers.

2. Maximum efficiency of diagnostics of perforative stomach ulcers and duodenum is reached when using the comprehensive diagnostic program including stage-by-stage use of diagnostic actions taking into account their resolution in each case.