Diagnostic Difficulties of Spontaneous Gastric Peforation in Adolescents

Abstract

Objective: Spontaneous gastric perforation (SGP) in adolescents is very rare. This study aims to evaluate the diagnostic difficulties and misdiagnoses associated with SGP. Methods: The medical records of patients that underwent surgery for a gastric perforation over the past 2 years at our paediatric surgery clinic were evaluated retrospectively. Patient demographics, symptoms, diagnostic evaluation, diagnostic difficulties, operative findings, and post operative clinical course were evaluated. Results: Seven patients were identified as having SGP. All of the patients were adolescents. Only 1 patient had a history of gastritis; the other 6 patients did not have a history of any disease, surgery or trauma. Radiological evidence of pneumoperitoneum using upright radiography was only found in 1 patient (16.6%). One patient was misdiagnosed and thought to have appendicitis. In 2 patients, the diagnosis was unclear, so diagnostic laparoscopy was performed. Conclusion: SGP can be seen in adolescents. However, sometimes it is difficult to diagnose. Even if all the imaging studies and laboratory tests are normal, if there is a sign of peritonitis upon physical examination, diagnostic laparoscopy could be performed.