Abdominal Pain In Children Research Articles

Isolated Fallopian Tube Torsion as a Cause of Acute Abdominal Pain in Children: A Case Report

Isolated fallopian tube torsion is a rare situation in reproductive-aged women. The gold standard for diagnosis is laparoscopic evaluation, and the treatment of choice is salpingectomy without oophorectomy to preserve fertility. Still, inpatient with a presentation of the acute abdomen or hemodynamically unstable, urgent laparotomy is the treatment of choice. Here, we reported a 15-year-old virgin girl presented with acute abdominal pain and evidence of adnexal torsion on the abdominal ultrasonography. Urgent laparotomy revealed an isolated right fallopian tube torsion. Due to irreversible necrosis of the tube, right salpingectomy was performed. It's crucial to consider isolated fallopian tube torsion as a potential cause of abdominal pain in reproductive-aged women and use appropriate diagnostic measures to diagnose it early and preserve their future fertility.

Detection of A2143G, A2142C, and A2142G Point Mutations with Real-Time PCR in Stool Specimens from Children Infected with Helicobacter pylori.

Reports have indicated an increasing prevalence of clarithromycin resistance in children relative to adults. Thus, it is important to investigate primary clarithromycin resistance before therapy to avoid treatment failure. A2142G, A2143G, and A2142C point mutations in the peptidyltransferase region of the 23S ribosomal RNA (rRNA) of Helicobacter pylori (H. pylori) strains isolated from children with gastrointestinal symptoms and asymptomatic children were evaluated via real-time polymerase chain reaction (RT-PCR) using fecal DNA samples. The presence of H. pylori was determined using a fecal H. pylori antigen enzyme-linked immunosorbent assay (ELISA) kit from the stools of children (n = 543). A2143G, A2142C, and A2142G point mutations were detected via RT-PCR and confirmed by sequencing the 23S rDNA. Fecal H. pylori antigen testing was positive in 101 symptomatic (49) and asymptomatic (52) children. A significant difference was found between the 0–5- and 5–18-year-old groups in terms of the A2143G and A2142G point mutations (p = 0.001). The A2142C mutation was not detected. There was a significant difference in the A2143G mutation between the symptomatic and asymptomatic 5–18-year-old children (p = 0.019). Macrolides are frequently used to treat upper respiratory tract infections in children due to their selective pressure effect. We suggest that H. pylori strains carrying mutations in the 23S RNA subunit conferring clarithromycin resistance may lead to an intense inflammatory response in the gastric epithelial cells, allowing them to proliferate more rapidly and causing possible diarrhea, halitosis, or abdominal pain in children.

Does Multisystem Inflammatory Syndrome Only Mimic Acute Appendicitis in Children or Can It Coexist: When Should We Suspect MIS-C?

Background and Objectives: Acute abdominal pain in children has been noticed to be a primary reason to seek medical attention in multisystem inflammatory disorder (MIS-C), which can prevail separately or together with acute appendicitis. Our aim was to distinguish regular appendicitis cases from MIS-C and to suggest the best clinical and laboratory criteria for it. Materials and methods: Cases of patients, admitted to the Pediatric Surgery Department over a six-month period in 2021, were retrospectively analyzed. Confirmed MIS-C or acute appendicitis cases were selected. MIS-C cases were either separate/with no found inflammation in the appendix or together with acute appendicitis. Acute appendicitis cases were either regular cases or with a positive COVID-19 test. Four groups were formed and compared: A-acute appendicitis, B-MIS-C with acute appendicitis, C-MIS-C only and D-acute appendicitis with COVID-19. Results: A total of 76 cases were overall analyzed: A-36, B-6, C-29 and D-5. The most significant differences were found in duration of disease A—1.4 days, B—4.5 days, C—4 days, D—4 days (p < 0.0001), C reactive protein (CRP) values A-19.3 mg/L B-112.5 m/L, C-143.8 mg/L and D-141 mg/L (p < 0.0001), presence of febrile fever A-13.9%, B-66.7%, C-96.6% and D-40% (p < 0.0001) and other system involvement: A 0%, B 100%, C 100% and D 20%. A combination of these factors was entered into a ROC curve and was found to have a possibility to predict MIS-C in our analyzed cases (with or without acute appendicitis) with an AUC = 0.983, p < 0.0001, sensitivity of 94.3% and specificity of 92.7% when at least three criteria were met. Conclusions: MIS-C could be suspected even when clinical data and performed tests suggest acute appendicitis especially when at least three out of four signs are present: CRP > 55.8 mg, symptoms last 3 days or longer, febrile fever is present, and any kind of other system involvement is noticed, especially with a known prior recent COVID-19 contact, infection or a positive COVID-19 antibody IgG test.

WE5.9 Management of acute abdominal pain in children at District General Hospital (DGH)

Abstract Introduction Children with acute abdominal pain are frequently seen in paediatric A&amp;E at DGH. Acute appendicitis is the most common surgical cause of acute abdominal pain in children. Diagnosis and management can be a problem in the absence of paediatric surgical unit Methods A retrospective study was conducted at a busy DGH where general surgical department is routinely involved in the management of acute abdominal pain in children. 6 months data was collected from 01/06/21 to 30/11/21. Results 381 patients (5–16 years) attended paediatric emergency with complaint of abdominal pain. 24% referred to surgeons (females 53%, mean age 10.9 years). All Presented with pain in RIF, migratory pain was in 42%. Nausea and vomiting were reported in 38%, loose stools in 10.8% and loss of appetite in 21.7%. Duration of pain vary between 24 hours to 3 weeks. WCC was raised in 32% patients, US was performed in 21.7%, CT scan in 5.4%, MRI 1%, and 1% had both Ultrasound and MRI. 46.7% did not have any radiological investigations. Appendectomy was performed in 21% (19) patients including laparoscopic in two. Duration of stay range from less than 24 hours to 5 days. 46.7% were discharged within 24 hrs of review, 21.7% stayed for one and only 2% stayed for five days. 1 patient was readmitted following a post operative collection that was managed conservatively. 2 referred to tertiary paediatric unit for complicated appendicitis. Conclusion This data proves that paediatric patients with suspected appendicitis can be safely managed in a surgical unit at DGH.

EP-66 Omental infarct – A rare cause of Right iliac fossa pain in a child

Abstract Introduction Idiopathic omental infarction is a very rare cause of abdominal pain in the pediatric age group. We report a case of suspected acute appendicitis in an 8-year-old child, noted to have omental infarct on diagnostic laparoscopy. Case presentation An 8-year-old male child with no other medical issues presented to the acute surgical take with a 2-day history of right iliac fossa pain. The pain was of sudden onset and there were no other associated urinary or bowel symptoms. On clinical examination, there was right iliac fossa tenderness. There were mildly raised inflammatory markers. An ultrasound scan performed showed a possible blind-ending tubular structure measuring 7mm in the right iliac fossa with a small amount of free fluids. A presumptive diagnosis of acute appendicitis was made and the patient was taken to theatre. Upon diagnostic laparoscopy, we noted blood in the RIF with a normal-looking appendix and area of omental infarction adjacent to the appendix. We proceeded to excise the area of mesenteric infarction using an energy device. The appendix was removed to avoid future diagnostic confusion. Conclusion Idiopathic omental infarction is an extremely rare cause of abdominal pain in children and may mimic acute appendicitis. Ultrasound imaging may be misleading. Laparoscopic exploration allows for accurate diagnosis as well as treatment.

Parental Knowledge of Appendicitis and Preference for Operative or Non-Operative Treatment at a United Kingdom Children's Hospital.

Appendicitis is a common cause of abdominal pain in children, and is the most common reason for children to undergo emergency abdominal surgery. To guide our research program in this field, we aimed to determine parental understanding with regard to appendicitis and its treatment. We also wished to assess parental preference for non-operative or surgical treatment of children with uncomplicated appendicitis. We asked parents attending a children’s outpatient clinic to complete a brief questionnaire that was interspersed with educational content to rectify any knowledge gaps. A total of 396 parents (of 414 approached) agreed to participate. There were gaps in parental knowledge, including not knowing where the appendix is located (one-third of respondents), not knowing what appendicitis is (40% of respondents), and underestimating the incidence of appendicitis. Parents typically overestimated the risks of complications and dying from both uncomplicated and complicated appendicitis. There was no influence of gender, age, or previous experience of appendicitis on these findings. When presented with the scenario of equal effectiveness of non-operative treatment and surgery for uncomplicated appendicitis, 59% of respondents expressed a preference for non-operative treatment over surgery, while 21% expressed a preference for surgery (20% expressed no preference). These findings are important for clinicians and researchers when discussing appendicitis and treatment options with families, and justify ongoing research into the comparative effectiveness of non-operative treatment and surgery.

Parental Involvement in Psychological Interventions for Recurrent Abdominal Pain in Childhood

ABSTRACT There are a variety of different psychological interventions used to treat recurrent abdominal pain in childhood. Active components in these interventions are unclear. Parents play an important role when it comes to their children's response to pain and management of pain, and are regularly involved in interventions. Four electronic databases were searched (CINAHL Complete, Medline, APA PsychArticles and APA PsychInfo) in order to examine in what ways parents are involved across different therapeutic modalities, and interventions delivered in a variety of formats. In this descriptive review of the literature, 30 studies were included with a total of 1848 participants ranging from age 4–18. The review also discusses the outcomes of studies involving parents. Most of the studies in this review involved parents through psycho-education about pain and strategies for managing pain, however, it remains unclear how parental involvement impacts outcomes. Further research is needed to determine the active components in psychological interventions for recurrent abdominal pain. This research should also include how parental involvement impacts these interventions.

Pediatric intussusception due to basidiobolomycosis: a case report and literature review

BackgroundPediatric gastrointestinal basidiobolomycosis is an unusual fungal infection caused by Basidiobolus ranarum, an environmental saprophyte found worldwide. Typically, basidiobolomycosis presents as a subcutaneous infection or soft tissue tumor-like lesion, and rarely involves the gastrointestinal tract. Gastrointestinal basidiobolomycosis is most common in young infants. It has no definitive clinical presentation, and almost all cases are misdiagnosed during the initial presentation.Case presentationWe report the case of a 4-year-old Saudi boy who presented to the emergency department with abdominal pain, nausea, vomiting, and weight loss. Ultrasonography revealed a target sign. Based on the ultrasonography findings, surgery was performed, which revealed the presence of intussusception. Eventually, the patient was diagnosed with intussusception secondary to intra-abdominal basidiobolomycosis based on the histological findings. The patient was readmitted and intravenous voriconazole therapy was initiated. One week after the second admission, the patient developed abdominal pain, nausea, vomiting, inability to hold down food, and constipation. Computed tomography of the abdomen was suggestive of small bowel obstruction, which was managed conservatively. The patient responded well and was subsequently discharged with a prescription of oral voriconazole.ConclusionsThis case reveals that gastrointestinal basidiobolomycosis can cause intussusception. This report will inform clinicians of the importance of considering gastrointestinal basidiobolomycosis in the differential diagnosis of chronic abdominal pain in children, even in the absence of fever or a clinically obvious abdominal mass, especially in countries such as Saudi Arabia, where cases have been reported.

Gastroduodenal Perforation in a Child With Sickle Cell Anemia: A Case Report

Objectives: Gastroduodenal perforation (GDP) is a rare cause of acute abdominal pain in children. Case Presentation: A 12-year-old boy presented with abdominal pain around the periumbilical and epigastric region on 7previous days. His familial history was significant for sickle cell anemia in the mother and minor thalassemia in the father. He had been diagnosed with sickle cell anemia at the age of 4 years and had received blood transfusion and hydroxyurea every month. At physical examination, a distended abdomen and decreased intestinal sounds were seen. Also, he had a history of cholecystectomy (for cholelithiasis). Fecal occult blood was detected, while no Helicobacter pylori antigen was present. Abdominal ultrasound examination revealed splenomegaly and evidence of free fluid. Surgical results showed bile discharge in the abdominal cavity, and perforation of duodenum and pylorus. Conclusions: Since the symptoms of GDP in children are non-specific, especially in children with sickle cell anemia, it should be considered in these patients with abdominal pain.

Omental infarction, unusual cause of abdominal pain

Omental infarction describes ischemic torsion of the distal portion of the omentum and constitutes an infrequent cause of acute abdominal pain in childhood of which few cases are known. Objec tive: To analyze through a clinical case the characteristics and management of this pathology, to consider this entity in the differential diagnosis of acute abdominal pain. An 11-year- old child consulted the emergency department due to a 48-hour history of continuous abdominal pain, which had progressively increased. On the physical examination, the patient presented pain in the right side of the abdomen and the epigastric area, with no signs of peritoneal irritation, and was overweight (BMI 91st percentile). Biochemical analysis showed a slight increase in c-reactive protein (CRP) 41.31 mg/L (reference value < 3.0 mg/L) without leukocytosis and normal ultrasound study, without visualization of the appendix. Due to persistent pain, increased CRP, and absence of appen dix visualization in the ultrasound, the study was completed with an abdomen and pelvis CT scan which showed trabeculation of the fat of the anterior right subhepatic space, thus diagnosing omental infarction. The patient was hospitalized for conservative management with analgesia, anti-inflamma tory drugs, and fluid therapy, presenting good evolution in the first 48 hours. Omental infarction is an infrequent cause of acute abdominal pain in childhood. Imaging studies play a funda mental role in the differential diagnosis of this entity with other clinical conditions of similar course, thus avoiding unnecessary surgical interventions.

Hypertriglyceridaemia in adolescents may have serious complications

Acute pancreatitis is an often-overlooked cause of acute abdominal pain in children and adolescents. Severe hypertriglyceridaemia is an important cause of recurrent acute pancreatitis. Monogenic causes of hypertriglyceridaemia, such as familial chylomicronaemia caused by lipoprotein lipase deficiency, are more frequently encountered in children and adolescents, but remain rare. Polygenic hypertriglyceridaemia is more common, but may require a precipitant before manifesting. With the global increase in obesity and type 2 diabetes, secondary causes of hypertriglyceridaemia in children and adolescents are increasing. We report two cases of severe hypertriglyceridaemia and pancreatitis in adolescent females. Hypertriglyceridaemia improved markedly with restriction of dietary fat. An inhibitor to lipoprotein lipase was found to be the cause in one patient, while in the other limited genetic investigation excluded chylomicronaemia owing to deficiency of lipoprotein lipase, its activators and processing proteins.

Correlation between fecal (calprotectin and lactoferrin) results and colonoscopic findings in chronic diarrhea and recurrent abdominal pain in children and adolescents

Background: Currently, endoscopy with biopsy is still considered the gold standard for the evaluation and diagnosis of mucosal inflammation and a number of scores exist to assess endoscopic activity in Crohn’s disease (CD) and ulcerative colitis (UC). Aim and objectives: the aim of the study was to determine the benefit of using both of fecal markers (calprotectin and lactoferrin) in patients presenting with chronic diarrhea and recurrent abdominal pain for differentiation between organic diseases, particularly inflammatory bowel disease (IBD) from non-organic disease, making colonoscope unnecessary. Subjects and methods: This prospective, observational and analytic study was carried out on 44 children who fulfilling the designed inclusion criteria. The study was carried out from Outpatient Clinic of Pediatric gastroenterology unit and from the Inpatient Units of the Pediatric department Faculty of Medicine, Al-Azhar University Hospitals (Al-Hussein &amp; Sayed Galal Hospitals), as well as referral from other hospitals complaining of recurrent abdominal pain and chronic diarrhea from March 2020 to March 2022. Results: there was statistically significant difference between IBD group and functional abdominal pain group as regard fecal calprotectin with p-value≤ 0.001. There was statistically significant difference between IBD group and functional abdominal pain group as regard fecal lactoferrin with p-value≤ 0.001.

Short study of acute appendicitis cases in pediatrics age groups

Acute abdominal pain in children represent a diagnostic dilemma, generally although many causes of acute abdomen are benign, other require rapid diagnosis and treatment to minimize morbidity. Numerous disorders can cause abdominal pain. The most common surgical cause is acute appendicitis. This study tries to evaluates the distribution of cases through the age and the fate of the management and complications that may occur during the course of the disease. This is a prospective study over a period of six months starting from March 15th to September 15th 2018. A total of 82 child were included in this study who are presented to our hospital complaining of acute appendicitis. The patients divided in to three groups according to their age, undergo careful clinical evaluation supplemented by laboratory and radiological investigations followed by surgical intervention and histopathological study. Eighty – two child suffering from acute appendicitis were included in this study, 44 male and 38 female , those 82 case undergone surgical line of appendectomy, no line of conservative treatment was applied and no any case of appendicular mass was included in this study ,seven cases from those patients were presented with generalized peritonitis due to perforated appendices. F

Importance and Role of Upper Gastrointestinal Endoscopy in Diagnosis of Recurrent Abdominal Pain in Children

Objective: The purpose of this study is to determine the effectiveness of upper gastrointestinal endoscopy in diagnosis of recurrent abdominal pain in children. Study Design:Retrospective study. Place and Duration: Department of Gastroenterology, HITEC-IMS Taxila Cantt. 1st July 2021-31st Dec 2021 Methods:There were 78 children of both genders with ages &gt;14 years were presented in this study. After obtaining the authority's informed written permission, we took detailed demographic information, such as age, gender, weight, and symptoms, for all of the recruited patients. All the patients were underwent for upper gastrointestinal endoscopy to diagnose recurrent abdominal pain. Prevalence of dyspepsia and H.pylori infection was also recorded among children. We used SPSS 23.0 to analyze complete data. Results: Among 78 children, 42 (53.8%) were boys and 36 (46.2%) were girls. Majority of the patients 45 (57.7%) were ages between 4-8 years followed by 9-14 years 25 (32.1%) and 8 (10.3%) were in age group 1-3 years. Most common symptom was anemia, followed by vomiting, haematemesis, melena and weight loss. Frequency of dyspepsia was found in 22 (28.2%) and helicobacter pylori found in 29 (37.2%) children. Most common diagnosis of endoscopy was gastritis found in 33 (42.3%) case, gastric erosions in 14 (17.9%) cases, hiatus hernia in 8 (10.3%) cases and remaining were gastric ulcer, gastric polyp and duodenitis. Hypoxemia, apnea and aspirationwere the most common complications found in our study. Conclusion: In this study, we found that upper gastrointestinal endoscopy remains an essential tool in the evaluation of RAP in children because it allows for accurate diagnosis of GI causes of RAP, despite reported complications such as hypoxemia, apnea, aspiration and choking, cardiac arrhythmias, bacteremia, perforation, and bleeding. Keywords:Upper GI Endoscopy, Findings, Complications, Children

Abdominal pain in children with intraabdominal purulent diseases and acute complications of type I diabetes mellitus: a non-systematic review

Annotation. The prevalence of type I diabetes mellitus (T1DM) among children in Ukraine reached 9105 patients in 2018 and continues to rise. Differential diagnosis of abdominal pain in ketoacidosis and intraabdominal purulent diseases is an important factor contributing to prompt and appropriate management of such patients. We analyzed the prevalence of T1DM in different age groups and specific features of abdominal pain related to its complications and concomitant intraabdominal purulent diseases in childhood in this article. Scientific research for the period from 2008 to 2021 was carried out according to the primary search strategy “type I diabetes mellitus” (T1DM, pediatric, children, prevalence), “ketoacidosis” (ketoacidosis, diabetic ketoacidosis, children), “abdominal pain” (acute abdominal pain, children), “acute appendicitis” (acute appendicitis, pediatric, children) and the combination of AND/OR in the scientometric databases MEDLINE (PubMed), Scopus, Web of Science. The leading role in the pathogenesis of pain belongs to electrolyte imbalance (acidosis) arising from the accumulation of intermediate products of fat oxidation. Abdominal pain in intraabdominal purulent diseases includes visceral, somatic parietal, and irradiating elements. The coincidence of onset peaks of intraabdominal purulent diseases, accompanied by acute abdominal pain and T1DM in this population requires the development of a standardized algorithm for the differential diagnosis of these pathologies.

Effects of probiotic supplementation on abdominal pain severity in pediatric patients with irritable bowel syndrome: a systematic review and meta-analysis of randomized clinical trials.

Probiotic supplementation has been used to alleviate abdominal pain in children and adolescents with irritable bowel syndrome (IBS), but the evidence is not compelling. Thus, a systematic review and meta-analysis of randomized clinical trials (RCTs) were performed to investigate the effects of probiotic supplementation on abdominal pain in pediatric patients with IBS. PubMed/MEDLINE, Web of Science, Scopus, Cochrane Library, and Embase were the available databases searched to find relevant randomized clinical trials up to April 2021. The effect size was expressed as weighted mean difference (WMD) and 95% confidence interval (CI). Seven RCTs with 441 participants were included, from which the meta-analysis demonstrated that probiotic supplementation has a significant effect on reducing abdominal pain in pediatric patients with IBS (WMD = - 2.36; 95% CI - 4.12 to - 0.60; P = 0.009). Although our study involved children and adolescents (≤ 18years), the effects of probiotic supplementation seem to be more potent in patients under 10years old (WMD = - 2.55; 95% CI - 2.84 to - 2.27) compared to patients aged 10-18years (WMD = - 1.70; 95% CI - 2.18 to - 1.22). The length of supplementation longer than four weeks was more effective (WMD = - 2.43; 95% CI - 2.76 to - 2.09). Probiotic supplementation can reduce abdominal pain in pediatric patients with IBS.

Role of H. Pylori infection with Recurrent Abdominal Pain in Young Age Children

Objective: A study was conducted to determine the incidence of Helicobacter pylori infection in children who had chronic abdominal pain. Study Design: Cross-sectional study. Study and Duration of Study: This research was carried out during 1.1.2019 to 1.6.2020 in the DHQ Sargodha. Materials and Methods: According to the findings, there were 200 participants in the study, and 8 percent of those with Recurrent Abdominal Pain had Helicobacter. Results: The patients ranged in age from 12.43 to 12.43 and 1.23 months on average. Between 8 and 16 years old, the average age of the sample group was observed. The average number of months that participants were bothered by stomach discomfort was 4.23. The presence of Helicobacter pylori was confirmed in 47% of those who were tested. Conclusion: Helicobacter pylori is a common cause of recurrent abdominal pain in children, and it can be treated with antibiotics. In children and adolescents, it is a serious problem, and more research is needed to determine the risk factor that is linked to an increased Helicobacter Pylori infection rate. Keywords: Recurrent Abdominal Pain, abdominal pain, Helicobacter pylori

Diagnostic performance of serum interleukin-6 in pediatric acute appendicitis: a systematic review.

Despite the radiological and analytical advances of the last decades, there is still a significant rate of diagnostic error in pediatric acute appendicitis. In recent years, multiple biomarkers have emerged as potential diagnostic tools. This study aimed to examine the diagnostic performance of serum interleukin-6 in pediatric acute appendicitis. We conducted a systematic review of the literature that involved an extensive search in the main databases of medical bibliography (Medline, PubMed, Web of Science and SciELO). Two independent reviewers selected the relevant articles based on the previously defined inclusion and exclusion criteria. Methodological quality of the selected article was rated using the QUADAS2 index. Data extraction was performed by two independent reviewers. The research in the medical bibliography databases resulted in 68 articles. We removed 26 duplicates. Among the remaining 42 articles, we excluded 33 following the inclusion and exclusion criteria. Of the final 9 studies included in this review, 8 provided measured serum interleukin-6 values, and all of them reported significant differences between groups, but inconsistent results regarding sensitivity and specificity. The diagnostic performance of interleukine-6 alone for the diagnosis of acute appendicitis in children is limited. The sensitivity and specificity of interleukine-6 for the diagnosis of non-complicated acute appendicitis in the pediatric population are moderate but increased in complicated appendicitis. There seems to be a direct relationship between serum level of interleukin-6 and the hours of evolution of abdominal pain in children with acute appendicitis. The increasingly widespread use of non-operative management of acute appendicitis warrants further exploration of the classificatory potential of this marker between complicated and uncomplicated appendicitis. We consider that this may be an avenue of research to explore in the future.

Risk Factors for Recurrent Abdominal Pain in Children with Nonorganic Acute Abdominal Pain.

PurposeThe purpose of this study was to identify the risk factors for recurrent abdominal pain (RAP) in children who presented with nonorganic acute abdominal pain.MethodsA retrospective, single study was conducted on 2–15-year-old children diagnosed with nonorganic acute abdominal pain at the pediatric outpatient department of Vajira Hospital, Nawamindradhiraj University, between January 2015 and December 2019. The potential risk factors were analyzed using univariate and multivariate analyses.ResultsOf the 367 patients with nonorganic acute abdominal pain, 94 (25.6%) experienced RAP within three months. In this group with RAP, 76 patients (80.8%) were diagnosed with functional gastrointestinal disorders, including functional dyspepsia, irritable bowel syndrome, functional abdominal pain-not otherwise specified, and functional constipation. History of gastrointestinal infection (p=0.011), mental health problems (p=0.022), abdominal pain lasting ≥7 days (p<0.001), and change in stool frequency (p=0.001) were the independent risk factors associated with RAP in children with nonorganic acute abdominal pain; their odds ratios and 95% confidence intervals were 3.364 (1.314–8.162), 3.052 (1.172–7.949), 3.706 (1.847–7.435), and 2.649 (1.477–4.750), respectively.ConclusionRAP is a common problem among children who first present with nonorganic acute abdominal pain. The identification of risk factors may provide proper management, especially follow-up plans for this group in the future.

Abdominal pain in children with COVID-19.

To analyze clinical features, diagnosis and treatment of pediatric patients referred to our pediatric surgery center with abdominal pain as a main manifestation of COVID-19. We retrospectively reviewed 56 patients with abdominal pain associated with SARS-CoV-2 infection at the Basrah Children Specialty Hospital between June 2020 and December 2021. We collected data including demographic data, symptoms, imaging data, laboratory findings, treatments, and clinical outcomes. Fifty-six patients (48 male and 8 female) with a median age of 9 years were analyzed. All patients had abdominal pain. Fifty-two patients complained of vomiting, 48 patients with fever, 36 patients with cough, and 20 patients with shortness of breath. Twenty patients were diagnosed with acute appendicitis, two of them had appendicular abscess. Mesenteric lymphadenitis was found in 12 patients, obstructed inguinal hernia in 4 patients, and epididymo-orchitis in two patients. Ten patients required surgical intervention. COVID-19 should be suspected in any child presenting with acute abdominal pain. In the era of COVID-19, all cases of abdominal pain in children including those with acute appendicitis are better to be treated conservatively.