Doctor Nguyen Thi Dinh, a specialist in pediatrics at Tam Anh General Hospital Hanoi, stated the patient had a duodenal bulb ulcer in the first part of the small intestine. The ulcer presented with a covered perforation, meaning adjacent organs temporarily sealed the hole, preventing widespread fluid leakage in the abdominal cavity. Increased intestinal pressure, however, could rupture this seal, causing generalized peritonitis.

Doctors review the patient's computed tomography scan. Photo: Tam Anh General Hospital

Doctors prescribed nil per os (NPO) for the child, inserting a gastric tube to drain fluid and reduce pressure. The patient also received high-dose intravenous antibiotics and proton pump inhibitors (PPIs) to control infection and promote ulcer healing.

Prolonged nil per os (NPO), however, increased the risk of malnutrition. Upon admission, Linh, at 1.61 m tall and 41.2 kg, had a BMI of 15.89 kg/m

2

, placing her at moderate to severe risk of protein-energy malnutrition. Inadequate nutrition would weaken her, delay ulcer healing, and increase complication risks.

To counter this, Doctor Nguyen Thi Phuong, from the Department of Nutrition, developed an individualized intravenous nutrition protocol. The plan aimed to provide Linh with ample energy and nutrients, while closely monitoring urine output, electrolyte levels, and liver and kidney function to tailor her nutritional intake.

After one week of intensive medical treatment, the patient's condition improved significantly. Linh's abdominal pain resolved, her gastric tube was removed, and she began eating orally. A CT scan confirmed the perforation had sealed, with no contrast medium leakage.

Linh continued proton pump inhibitors, a soft diet, and supplements of zinc and B vitamins. She received guidance on nutrition and lifestyle, with a follow-up appointment scheduled in 4 weeks.

Doctor Dinh advised parents not to overlook recurrent dull abdominal pain in children, especially if it worsens when hungry or after eating. She urged them to seek immediate medical attention for their child.

Thuy Hanh

*Patient's name has been changed