Value of abdominal sonography in the assessment of children with abdominal pain.

Abstract

We retrospectively evaluated the usefulness of sonography in the diagnostic assessment of children with abdominal pain. From July 1988 to October 1996, 676 children who had abdominal pain and were referred for sonography underwent abdominal and pelvic sonographic examination. Of these, 644 children had recurrent abdominal pain (RAP) and 32 children had acute or subacute abdominal pain (ASAP). The mean ages and relative risks of underlying abnormalities were calculated for children with RAP and ASAP. Abdominal abnormalities were sonographically detected in 10 children with RAP (2%), a significantly lower incidence than in children with ASAP (56%, p < 0.0001), with a relative risk of 0.028 (95% CI, 0.014-0.055). In the RAP group, an underlying abnormality was more likely (p < 0.001) to be sonographically detected in children who had atypical clinical features (5 of 46%; 11%) than in those with typical clinical features (5 of 598; 1%), with a relative risk of 12.94 (95% CI, 3.90-43.30). Children with RAP were found to have hydronephrosis (3), urinary cystitis (2), duplex kidney (1), hypoplastic low-lying kidney (1), choledochal cyst (1), ovarian teratoma (1), and gross gaseous distention with fecal masses (1). Children with ASAP had urinary cystitis (4), intussusception (2), appendicitis (2), appendiceal abscess (1), perforated gut with ascites (1), gut duplication (1), thickened gut wall with fluid from severe gastroenteritis (1), gross gaseous distention with fecal masses (1), hepatosplenomegaly (1), cholecystitis (1), gross hydronephrosis (1), Wilms' tumor (1), and abdominal neuroblastoma (1). Abdominal sonography is useful in children with ASAP. Although an underlying abnormality was rarely found in children with RAP, children who have RAP with atypical clinical features should have sonographic screening. If no abnormalities are found, the normal sonograms may be reassuring to parents.