Over-the-Counter Ibuprofen-Induced Pre-Pyloric Gastric Perforation in a 28-Month-Old Child: A Rare Pediatric Case

TL;DR

A 28-month-old child developed a rare stomach perforation after taking over-the-counter ibuprofen with steroids, highlighting the need for caution with such medications in children.

Contribution

This case report highlights the rare but serious risk of gastric perforation in children from over-the-counter ibuprofen combined with steroids.

Findings

A 28-month-old child developed pre-pyloric gastric perforation after using ibuprofen and steroids.

Laparoscopy and laparotomy confirmed the perforation, requiring surgical repair.

No evidence of hypergastrinemia or Helicobacter pylori was found.

Abstract

Gastric perforation is a rare but potentially life-threatening cause of acute abdomen in pediatric patients beyond the neonatal period. Over-the-counter ibuprofen, often administered without physician oversight, can exacerbate gastric mucosal injury, particularly when used concurrently with corticosteroids. We describe the case of a 28-month-old male with bronchial asthma who developed acute epigastric pain, vomiting, and low-grade fever after receiving four doses of over-the-counter ibuprofen alongside prescribed oral steroids. Abdominal examination and investigations revealed generalized tenderness, elevated inflammatory markers, and pneumoperitoneum on radiographs. Diagnostic laparoscopy identified a pre-pyloric gastric perforation; however, tissue friability necessitated laparotomy and Graham patch repair. Postoperative recovery was uneventful, and further evaluation excluded hypergastrinemia and Helicobacter pylori infection. This case underscores the importance of thorough medication history-taking and highlights the need for heightened clinical suspicion of pediatric gastric perforation when multiple risk factors, such as the use of non-steroidal anti-inflammatory drugs and corticosteroids, are present. Prompt diagnosis, timely surgical intervention, and increased public health awareness of the risks associated with over-the-counter non-steroidal anti-inflammatory drugs in children are critical to reducing morbidity associated with this rare complication.

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