”Multiple Perforated Gastric Ulcers Causing Peritonitis in a Pediatric Patient with Diabetic Ketoacidosis: A Case Report and Literature Review”

Introduction :Diabetic ketoacidosis (DKA) is a severe and life-threatening complication that primarily occurs during the onset of type 1 diabetes mellitus (T1DM). (2) (3) The clinical manifestations of DKA include altered consciousness, fatigue, polydipsia, irritability, nausea, and vomiting. However, in some cases, patients with DKA may present only with abdominal pain.(4) Although gastrointestinal (GI) bleeding in DKA has been reported in a few cases, there remains a significant lack of studies on this association.(5)In adults with DKA, there is a 9% incidence of upper GI bleeding, and erosive esophagitis is among the most common lesions observed during endoscopy. Elevated creatinine, BUN, and glucose levels are laboratory values associated with an increased risk of upper GI bleeding during DKA.(6)(7 ) although no cases have been documented in children (8). Upper GI bleeding may occur due to perforated gastric ulcer; however, the coexistence of DKA with gastric ulcer perforation is an extremely rare combination, and only one case has been reported to our knowledge (9).Here,we present a case of a 16-year-old male with T1DM who was admitted with severe abdominal pain associated with fever, vomiting, and a decreased level of consciousness. He was diagnosed with DKA and peritonitis due to multiple perforated gastric ulcers, requiring a subtotal gastrectomy and an extended recovery period. This case highlights the rare occurrence of gastric perforation alongside DKA and emphasizes the critical need for early recognition and intervention in such complex situations. detailing clinical presentation, management, and outcomes was reported in compliance with SCARE guidelines(1) .