A Case of Perforated Duodenal Ulcer in an Infant.

The following case of perforated duodenal ulcer in an infant is reported, not only on account of the raritv of the condition, but also because the symptoms and course presented differ somewhat from those in previouslv reported cases. Peptic ulcers are evidently not very rare in infants under one year of age, but onlv a few have been recorded in England. In Welch's1 collection of 6074 cases of peptic ulcer onlone occurred under ten yvears of age. Koplih2 reported one case of peptic ulcer out of 300,000 cases of diseases of children, and RokitanskV3 stated that he never saw a case under fourteen years. In 1926 Theile4 collected 248 cases of peptic ulcers in children; 138 of these occurred in the first y-ear, and one-third of the entire series in the first month of life; 38 per cent. were duodenal and 42 per cent. gastric. Altogether. duodenal seem to occur more frequentlv than gastric ulcers. In 364 autopsies under one yvear Entz5 found ten duodenal and onlyone gastric ulcer. Females are more commonlyaffected than males. The age incidence seems to correspond to that of marasmus. Holt_6 in 65 cases noted that 70 per cent. occurred between six weeks and five months. Perforation.-Although over 200 cases of duodenal ulcer in infants have been recorded in the literature, onlv nine cases of perforation have been found. Nevertheless, Adler7 remarks on the large percentage of perforations which occur in acute ulcers in children. The following have each reported one case of perforated duodenal ulcer in infants under one year: Borland8, Adriance9, Finnviu, HelmholzLl, Griffith12, Schmidt13, and Somerford14. Entz5 has recorded two instances.