Surgical management of acute abdomen in children with autism

Abstract

Objective To summarize the clinical characteristics and treatment experiences of acute abdomen in autistic children. Methods Retrospective analyses were performed for 3 autistic children of acute abdomen during the period of June 2011 and January 2013. The relevant clinical characteristics included disease duration, onset of symptoms, signs, accessory examinations, tentative diagnosis, intraoperative findings and postoperative recovery. Results The onset periods were 7 hours, 3 days and 20 days respectively. The clinical symptoms included vomiting, behavioral changes and walking stooped. There were no flatus or constipation （n = 1）, diarrhea （n = 2） and fever （n = 3）. Physical examination was non-cooperative. There were abdominal distension （n = 1 ）, abdominal muscle guarding （n = 1） and resistance to abdominal pressing （n = 1） because of insensitivity to pain. White blood cells were all elevated （10. 3-17. 2×10^9/L）. Liquid-gas plane was present on X-ray in 1 case and type B ultrasound showed abdominal effusion in 2 cases. All underwent surgical exploration including 2 laparoscopic procedures. One case was intraoperatively diagnosed as acute appendicitis with perforation, was another as appendiceal abscess ＆ intestinal obstruction and a third as Meckel＇s diverticulum suppuration ＆ perforation. All recovered well after operation. Conclusions For acute abdomen in children with autism, objective behaviors are more important than subjective symptoms. There is some gap between patient conditions and complaint time. A preoperative diagnosis is often rather difficult. For avoiding delayed treatment, emergency operation is required when surgical indications arise. Timely surgery may achieve satisfactory outcomes. Key words: Abdomen, acute; Mental disorders diagnosed in childhood; Digestive system surgical procedures