Gastric and duodenal ulcers complicating intracranial disease must be recognized promptly. In 1932, Cushing1 reported 11 patients with central nervous system disease complicated by hemorrhage or perforation of a gastric or duodenal ulcer. Ninety-two duodenal ulcers and 26 gastric ulcers in pediatric patients have been diagnosed at the University of Nebraska Hospital and Childrens Memorial Hospital in Omaha and the University of Illinois Hospital in Chicago, collectively. Of these 26 gastric ulcer patients, four had perforations of their ulcers; all four patients had brain disease. Of the 93 duodenal ulcer patients, only one had a perforation. All five patients with a perforated ulcer were diagnosed at the University of Illinois Hospital.
Five children have been treated at the University of Illinois Hospital for perforation of a gastric or duodenal ulcer since 1945 (Table 1). Three of these patients had brain tumors, one had meningitis, and one had