ACUTE PERFORATED JEJUNAL ULCER IN A CHILD WITH JUVENILE DERMATOMYOSITIS (CASE REPORT)
Abstract
Background. Juvenile dermatomyositis (JD) is an inflammatory myopathy in children with predominant involvement of the proximal muscles of the extremities, the development of systemic vasculitis and characteristic skin changes. It is accompanied by progressive muscle weakness, including smooth muscles of the respiratory and digestive organs, as well as striated muscle tissue of the heart. Joint damage and calcification are noted. JD is confirmed by the detection of myositis antibodies in the blood. Corticosteroids and cytostatics are usually prescribed. It should be noted that as of 2023, only 4 patients with this disease were registered in the Republic of Belarus. Objective. To demonstrate a rare case of diagnosis and treatment of perforated jejunal ulcer in a child with JD. Material and methods. Data from the clinical observation of patient Sh., aged 3, treated in the department of emergency surgery of Grodno Regional Children's Clinical Hospital in October 2023. Results. The child was admitted to the children's hospital complaining of abdominal pain, vomiting (3 times), the duration of the disease being 17 hours. The dynamic observation revealed no acute surgical pathology. Acute gastritis was diagnosed, the concomitant pathology being JD (acute course, 2nd degree activity). On the 5th day (on the day of discharge) the child had a sudden bloating. Plain radiography revealed free gas under the diaphragm. The child underwent diagnostic laparoscopy that detected a perforated jejunal ulcer with peritonitis. Laparotomic jejunum resection with anastomosis was performed. Conclusions. We have presented a case, which the surgeons of our hospital have faced for the first time. Having analyzed literature data, we came to the conclusion that the complication was related to the underlying disease and its therapy with corticosteroids. Despite the complexity of the disease, the patient was discharged with an improvement in his condition.
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