Abstract
Gastric perforation is a rare but potentially life-threatening cause of acute abdomen in pediatric patients beyond the neonatal period. Over-the-counter ibuprofen, often administered without physician oversight, can exacerbate gastric mucosal injury, particularly when used concurrently with corticosteroids. We describe the case of a 28-month-old male with bronchial asthma who developed acute epigastric pain, vomiting, and low-grade fever after receiving four doses of over-the-counter ibuprofen alongside prescribed oral steroids. Abdominal examination and investigations revealed generalized tenderness, elevated inflammatory markers, and pneumoperitoneum on radiographs. Diagnostic laparoscopy identified a pre-pyloric gastric perforation; however, tissue friability necessitated laparotomy and Graham patch repair. Postoperative recovery was uneventful, and further evaluation excluded hypergastrinemia and Helicobacter pylori infection. This case underscores the importance of thorough medication history-taking and highlights the need for heightened clinical suspicion of pediatric gastric perforation when multiple risk factors, such as the use of non-steroidal anti-inflammatory drugs and corticosteroids, are present. Prompt diagnosis, timely surgical intervention, and increased public health awareness of the risks associated with over-the-counter non-steroidal anti-inflammatory drugs in children are critical to reducing morbidity associated with this rare complication.