Duodenal perforation caused by deferasirox "case report"

Introduction: Gastrointestinal tract perforations are relatively rare in children. Patients who re-ceive repeated blood transfusions are susceptible to iron overload with its own associated com-plications. To obviate these complications, iron chelation therapy with deferasirox is the treat-ment of choice. One of the rare complications of chronic treatment with deferasirox is gastroin-testinal perforations. The aim of this report is to outline aspects of diagnosis, management, and the role of minimal invasive surgery in the management of this rare complication.Case presentation: This report describes a case of duodenal perforation in a 5-year-old patient with beta-thalassemia receiving multiple blood transfusions and on chronic chelation with de-ferasirox. She presented to the emergency department with vomiting and diarrhea of 5 days du-ration and diagnosed to have acute viral gastroenteritis. She was admitted to the pediatric med-ical ward and later on the same day she developed severe abdominal pain, mostly in the epigas-tric region. On physical examination, she was initially afebrile but later developed fever (38.9 degrees C). She was also tachycardic (a heart rate of 130 beats/min), and tachypneic (a breath-ing rate of 24-28 breaths per minute). Her blood pressure was 115/76 mmHg. Her abdominal examination revealed generalized abdominal tenderness with guarding and mildly reduced bowel sounds. An erect abdominal x-ray revealed free intraabdominal air which was confirmed by an abdominal CT scan. The diagnosis of gastrointestinal perforation was made, and the pa -tient was prepared for an emergent diagnostic laparoscopy which revealed a duodenal perfora-tion in the anterior aspect of the first part of the duodenum. Primary repair of the perforation was done, followed by reinforcement with a Graham patch and peritoneal lavage. Postopera-tively she did well and was discharged home on the 8th postoperative day.Conclusions: Deferasirox induced duodenal perforation is very rare. Duodenal perforation should be suspected in patients with severe gastrointestinal symptoms and abdominal tenderness while on Deferasirox, especially at high doses (30+ mg/kg). Awareness of this rare complication is im-portant to avoid delay in diagnosis and treatment with its known sequalae. Once suspected the diagnosis can be confirmed and managed laparoscopically.