The acute abdomen in female children.

Abstract

SummaryThe findings based on a study of 734 girls between two and 15 years of age who were seen with a suspected acute surgical abdomen have been reviewed. Two hundred twenty‐seven (31 percent) were not thought to have a surgical lesion and were not operated upon. Five hundred seven were submitted to surgery, and in 120 (23 percent of those operated upon) either no definite diagnosis was made or a nonsurgical condition was found. The most significant nonsurgical lesions giving rise to the clinical features of an acute surgical abdomen were mesenteric lymphadenitis, acute gastroenteritis, the redundant sigmoid syndrome, acute pyelonephritis, and pneumonia. In most instances the diagnosis of these conditions was made on clinical grounds, but on some occasions exploration was necessary because the signs were so strongly suggestive of a localized inflammatory or obstructive lesion.Acute appendicitis was by far the most common surgical lesion causing abdominal pain. Two hundred ninety‐seven girls suffered from this disease. Under the age of six years, the incidence of perforation was 63 percent. The overall incidence was 24 percent.Next to acute appendicitis, gynecological lesions were the most common ones to present the features of an acute abdomen in girls between 11 and 15 years of age. They accounted for the clinical features of an acute abdomen in almost 10 percent of this age group. A ruptured graafian follicle was the most common lesion followed by torsion of the ovary, ruptured corpus luteal cyst, torsion of a parovarian cyst, tubovarian abscess, and reflux of menstrual blood. Intestinal obstruction was the cause of the acute abdomen in 30 girls. Between two and four years the commonest cause was an intussusception, but after four years of age it was a postoperative adhesion. A diagnosis of primary peritonitis was made in 23 girls. In only one was a positive bacterial culture obtained from the peritoneal fluid. It would appear that a virus may well be responsible for this clinical entity. Gall bladder disease and perforated peptic ulcers accounted together for 0.5 percent of the girls seen between two and 15 years. Trauma was a rare cause and accounted for the clinical features in only two cases.Under the age of two years the features of the acute abdomen were due to intestinal obstruction in over 90 percent of girls. In the neonatal period signs of obstruction, and not pain, predominated.