Duodenal ulcer perforation presenting as acute appendicitis in a child: a case report and literature review

Introduction Duodenal ulcer perforation (DUP) is exceedingly rare in the pediatric population. Its clinical presentation frequently mimics acute appendicitis (AA), leading to a high risk of preoperative misdiagnosis and posing substantial diagnostic and therapeutic challenges. Case presentation We describe a 12-year-old boy who presented with signs and symptoms suggestive of acute appendicitis. Emergency diagnostic laparoscopy revealed a 0.6-cm perforation on the anterior wall of the duodenal bulb. The perforation was successfully repaired laparoscopically. The patient had an uneventful postoperative recovery, and follow-up endoscopy confirmed complete mucosal healing. Discussion This case highlights that pneumoperitoneum in pediatric patients presenting with AA-like symptoms should prompt consideration of DUP in the differential diagnosis. Diagnostic laparoscopy is instrumental in establishing an accurate diagnosis and enabling timely, minimally invasive treatment. Conclusion In children with atypical acute abdominal pain, heightened clinical suspicion for DUP, particularly when imaging reveals pneumoperitoneum, combined with proactive use of laparoscopy, can reduce misdiagnosis and improve patient outcomes.