The child was admitted to the hospital in the 20th hour of acute abdominal pain, initially with subtle pain in the epigastric region, then gradually increasing and spreading to the right and lower pelvic cavities, accompanied by anorexia and nausea. The child was taken by his family to a private hospital for examination and diagnosed with appendicitis, then transferred to Hanoi Children's Hospital for further treatment.
Upon admission, the patient was awake, not feverish but had a lot of pain in the right abdomen. The examination recorded mild abdominal distension, with abdominal wall reactions in the right pelvic cavity and lower abdomen. Previous tests showed that the infection was increasing. Abdominal ultrasound detected a lot of free fluid and infiltrated the right abdomen. However, the computed tomography (CT) image did not record large appendicitis or free gas in the abdomen, making diagnosis of the main cause difficult.
Faced with the obvious condition of peritonitis, the patient was indicated for emergency surgery with an initial diagnosis of peritonitis suspected to be appendicitis.
During the endoscopic examination, doctors discovered that the abdominal cavity had a lot of digestive juice, mainly concentrated in the right iliac fossa and lower abdomen. Abdominal walls were edgy, congested but without pseudomembrane. The appendicitis was only mild congestion, no signs of inflammation, excluding the cause of acute appendicitis.
Continuing to examine the gastroduodenal region, doctors recorded a slight dilation of the stomach and discovered a small hole of about 0.5 cm in the front of the duodenum. The tissue around the hole was edgy, with the pseudomembrane covering a part, making the lesion difficult to detect on pre-operative diagnostic images.
The surgical team closed the puncture by endoscopic method, cleaned the abdominal cavity and placed drainage. The surgery was performed safely and effectively, minimizing invasion for the patient.
After surgery, the child was awake, clearly reduced pain, the abdomen gradually softened, eating and drinking returned early and no complications were recorded. The patient was discharged from the hospital after 7 days of treatment, in stable condition.
BSCKII Tran Van Quyet - Head of General Surgery Department, Hanoi Children's Hospital recommends: Parents need to take their children to the doctor early when there are symptoms such as epigastric pain, heartburn, acid reflux or a burning sensation in the navel area. Early screening and treatment of gastritis - stomach ulcers, duodenal ulcers will help prevent dangerous complications such as duodenal perforation. Treatment needs to fully comply with the doctor's instructions to achieve the best effect.
