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The following is a summary of “Perforated peptic ulcers in children: a systematic review,” published in the May 2025 issue of BMC Pediatrics by Vidović et al. 

Researchers conducted a retrospective study to outline the risk factors, etiology, treatment modalities, and outcomes in children with perforated peptic ulcers (PPU), as no systematic review on the topic existed.    

They executed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A literature search was completed on 24 November 2024 across 4 electronic databases: Web of Science, Scopus, PubMed, and ScienceDirect. Studies published in English on pediatric patients with PPU were included. Exclusion criteria comprised non-English publications, conference abstracts, personal communications, single case reports, studies on non-perforated ulcers, participants older than 18 years, and those reporting perforations outside the stomach or duodenum.    

The results showed that out of 1,963 identified records, 12 studies met the inclusion criteria, analyzing 239 children with PPU, with a median age of 11 years (range 3.2–16.5 years). Ulcer perforations were more common in males (74.8%), with duodenal perforations (73%) being more frequent than gastric perforations (27%). The most common symptoms were abdominal pain (73.2%), vomiting (34.3%), peritoneal signs (33%), and fever (15.9%). Subdiaphragmatic free air was found in 58.9% of patients. Surgical treatment was given to 86.6% of patients, while 13.4% received conservative care. Most surgeries were open (69%), with 31% undergoing laparoscopic repair. Of the surgical procedures, 114 involved simple sutures, with or without an omental patch. Postoperative complications occurred in 14.5% of cases, reoperation was required in 1.9%, and mortality was recorded in 3.8% of patients.    

Investigators concluded that PPU was more common in males and primarily located in the duodenum, with ulcer suturing, with or without an omental patch, being the most common treatment, showing a low complication rate. 

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-025-05725-2