# 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.

## Key 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.