Abstract
Introduction: Perforated duodenal ulcer is an exceptionally rare and life-threatening condition in infancy, typically associated with secondary causes such as Non-steroidal anti-inflammatory drug use, systemic illness, or Helicobacter pylori infection. Truly spontaneous perforation in a previously healthy infant is extraordinarily uncommon and scarcely reported.
Case Presentation: We report a 1-year-old male infant who presented initially with several days of non-bil ious brownish vomiting and iron deficiency anemia, without signs of acute abdomen. He was discharged against medical advice and re-presented 10 days later with progressive abdominal distension, tenderness, fever, and bloody gastric aspirate. Laboratory evaluation revealed anemia, thrombocytopenia, and markedly elevated inflammatory markers, while H. pylori testing was negative. Abdominal radiography showed diffuse bowel distension without definitive pneumoperitoneum, and ultrasound raised concern for bowel obstruction. Exploratory laparotomy revealed approximately 600 ml of purulent peritoneal fluid and a solitary 5-7 mm anterior perforation in the first part of the duodenum, with otherwise healthy surrounding tissue and no additional gastrointestinal pathology. Primary repair with interrupted sutures and omental patch reinforcement was performed. The postoperative course was complicated by intragastric hematoma, suspected portal vein thrombosis, and anemia requiring transfusion. The patient gradually improved and was discharged on postoperative day 16 on proton pump inhibitor therapy, with a favorable short-term outcome.
Conclusion: This case highlights that spontaneous duodenal perforation can occur in infants without identifiable risk factors and may present atypically with delayed diagnosis. A high index of suspicion and early surgical intervention are essential to reduce morbidity in this rare but serious condition.

Key words: Keywords: duodenal perforation; infant; peptic ulcer disease; spontaneous perforation; case report