Medico-Legal Update

Open Access Open Access  Restricted Access Subscription Access
Open Access Open Access Open Access  Restricted Access Restricted Access Subscription Access

Fatal Curling's Ulcer after Burns in a Child-a Case Report


Affiliations
1 Department of Forensic Medicine & Toxicology Kasturba Medical College, Manipal, India
2 Department of Forensic Medicine, KSHEMA, Nitte University, Mangalore, India
3 Department of Forensic Medicine & Toxicology, K S Hegde Medical Academy, Nitte University, Mangalore, India
4 Department of Forensic Medicine & Toxicology, Kasturba Medical College, Manipal University, Manipal, India
     

   Subscribe/Renew Journal


Burns are the most frequently recognized severe form of trauma occurring in childhood. The association of acute gastrointestinal tract disease with burn injury is known since first half of the 19th century. Curling's ulcer is a recognized complication of burn shock which occurs in the gastrointestinal tract in burned patient. It manifest during the second week, when infection and toxic absorption from the separating sloughs is predominant. It will be diagnosed only in the event of haemorrhage, perforation, or at necropsy, and presumably these do not occur in every case. Prognosis in Curling's ulcer is always serious, especially in children, death occurring most often from haemorrhage or perforation.

A rare case of acute duodenal ulcer in a nine-month-old infant after deep burns of both lower extremities is described. It gives the impression that it is necessary to take into consideration the possibility of Curling's ulcer in every case of deep and extensive burns in children.


Keywords

Burns, Curling's Ulcer, Haemorrhage, Perforation
Subscription Login to verify subscription
User
Notifications
Font Size


  • Haubrich, Schaffner, Berk: Bockus Gastroenterology, W. B. Saunders company, 5th edition, 1995, vol 1, 660, 684 – 688.

  • Ian FK, Muir, Peter F Jones. Curling’s ulcer: A rare condition. Br. J. Surg 1976: 63: 60 – 66.

  • Fadaak HA. Gastrointestinal haemorrhage in burn patients the experience of a burns unit in Soudi Arabia. Annals of Burns and Fire Disasters. June 2000; 13(2): 81.

  • Swan, J.: Case of Severe Burn. Edinburgh Med. J., 19:344, 1823.

  • Curling, T. B.: On Acute Ulceration of the Duodenum, in Cases of Burns. Medico-Chir. Trans. Lond., 25:260, 1852.

  • Pruitt B A, Foley FD, Moncrief JA. Curling’s Ulcer: A Clinical-Pathology Study of 323 Cases. Annals of Surgery October 1970, vol. 172(4); 523 – 536.

  • Sevitt Simon, Duodenal and Gastric ulceration after burning. Brit. J. Surg. 1967: 54(1): 32 – 41.

  • Pruitt BA. The burn patient: II later care and complications of thermal injury. Curr Probl Surg 1979;16:69–70.

  • Czaja A.J., McAlhany J.C., Andes W.A. et al.: Acute gastric disease after cutaneous thermal injury. Arch. Surg., 110: 600-5, 1975.

  • Czaja A.J., McAlhany J.C., Pruitt B.A.: Acute duodenitis and duodenal ulceration after burns. JAMA, 232: 621-6, 1975.

  • Pingleton S.K., Hadzima S.K.: Enteral alimentation and gastroduodenal bleeding in mechanically ventilated patients. Crit. Care Med., 11: 13-18, 1983.

  • Moscona. R., Kaufman T., Jacobs R., Hirshowitz B.: Prevention of gastrointestinal bleeding in burns. The effects of cimefidine or antacids combined with early enteral feeding. Burns, 12: 65-7, 1985.

  • Choctaw W.T., Fujita C., Zawacki B.E.: Prevention of upper gastrointestinal bleeding in burn patients: A role for “elemental” diet. Arch. Surg., 115: 1073- 6, 1980.

  • Solem L.D., Strate R.G., Fischer R.P.: Antacid therapy and nutritional supplementation in the prevention of Curling’s ulcer. Surg. Gynecol. Obstet., 148: 367-70, 1979.

  • Raff T., Germann G., Hartmann B.: The value of early enteral nutrition in the prophylaxis of stress ulceration in the severely burned patient. Burns, 23: 313-8, 1997.

  • Yang C.H., Hsu W., Shin T. (eds.): “Treatment of burns”. SpringerVerlag, Berlin, 1982.

  • Blundell A. Non-fatal case of Curling’s ulcer in a child. British Medical Journal. July 17, 1954:133 – 134.

  • Pruitt BA, Goodwin CW. Stress ulcer disease in the burned patient. World Journal of Surgery. 1981;5(2): 209-220,

  • Agarwal SS, Kumar Lavlesh, Chavali KH, Jhaveri SH. Fatal Gastro-Intestinal Bleeding – A Complication Following Spinal Injury. JIAFM, 2005; 27(3): 192 – 194.

  • Kirksey TD, Moncrief JA, Pruitt BA Jr, O’Neill JA Jr. Gastrointestinal Complications in Burns. Amer J Surg. 116:627, 1968.

  • Goldman H, Rosoff CB, Pathogenesis of Acute Gastric Stress Ulcers. J. Path., 52:227, 1968.

  • Fadaak H.A. Gastrointestinal haemorrhage in burn patients the experience of a burns unit in Saudi Arabia. Annals of Burns and Fire Disastersvol. XIII - n. 2 - June 2000.


Abstract Views: 703

PDF Views: 11




  • Fatal Curling's Ulcer after Burns in a Child-a Case Report

Abstract Views: 703  |  PDF Views: 11

Authors

Shankar M Bakkannavar
Department of Forensic Medicine & Toxicology Kasturba Medical College, Manipal, India
Vinod C Nayak
Department of Forensic Medicine, KSHEMA, Nitte University, Mangalore, India
Pratik V Taravadi
Department of Forensic Medicine & Toxicology, K S Hegde Medical Academy, Nitte University, Mangalore, India
G Pradeep Kumar
Department of Forensic Medicine & Toxicology, Kasturba Medical College, Manipal University, Manipal, India

Abstract


Burns are the most frequently recognized severe form of trauma occurring in childhood. The association of acute gastrointestinal tract disease with burn injury is known since first half of the 19th century. Curling's ulcer is a recognized complication of burn shock which occurs in the gastrointestinal tract in burned patient. It manifest during the second week, when infection and toxic absorption from the separating sloughs is predominant. It will be diagnosed only in the event of haemorrhage, perforation, or at necropsy, and presumably these do not occur in every case. Prognosis in Curling's ulcer is always serious, especially in children, death occurring most often from haemorrhage or perforation.

A rare case of acute duodenal ulcer in a nine-month-old infant after deep burns of both lower extremities is described. It gives the impression that it is necessary to take into consideration the possibility of Curling's ulcer in every case of deep and extensive burns in children.


Keywords


Burns, Curling's Ulcer, Haemorrhage, Perforation

References