# A Rare Case of Concomitant Duodenal and Gallbladder Perforation in a Pediatric Patient

## TL;DR

A rare case of simultaneous duodenal and gallbladder perforation in a child is reported, highlighting the challenges in diagnosis and the need for urgent surgical intervention.

## Contribution

The paper presents a unique pediatric case of concomitant duodenal and gallbladder perforation, emphasizing diagnostic challenges and surgical urgency.

## Key findings

- Concomitant duodenal and gallbladder perforation is exceptionally rare in children.
- The case suggests a possible pathophysiological link between duodenal ulcers and gallbladder inflammation.
- Early surgical exploration is critical in critically ill children with rapid clinical deterioration.

## Abstract

Concomitant perforation of the duodenum and gallbladder is exceptionally rare in the pediatric population. These conditions pose significant diagnostic and therapeutic challenges, particularly in critically ill or sedated children.

We report the case of a five-year-old girl who was initially hospitalized for posterior fossa tumor resection and developed acute abdominal distension, anemia, and hematemesis in the postoperative period. Imaging was limited because of the hemodynamic instability. Emergency exploratory laparotomy revealed a large duodenal perforation and a concomitant gallbladder perforation. The surgical management included primary duodenal repair, cholecystectomy, and gastroduodenal bypass. Despite intensive supportive care, the patient succumbed to sepsis and multiorgan failure on postoperative day 2.

This case highlights the diagnostic difficulty of gastrointestinal perforations in sedated intensive care unit patients, the possible pathophysiological link between duodenal ulcers and adjacent gallbladder inflammation, and the urgency for surgical intervention.

Clinicians should maintain a high index of suspicion of stress-related gastrointestinal complications in critically ill children. Early surgical exploration may be life-saving when imaging is inconclusive and clinical deterioration is rapid.