Acute Abdominal Pain In Children Research Articles

Causes and Management of Acute Abdominal Pain in Children: A Review Article

Acute abdominal pain is one of the commonest prevalent grievances in children, and it frequently requires emergency room diagnosis and management. Abdominal pain in children differs with age, concomitant symptoms, and pain site. While most cases of acute abdominal embarrassment are self-limiting and benevolent, there are certain diseases that can be life-threatening and necessitate instant care, such as appendicitis, intussusception, or intestinal obstruction. To decide the cause of acute abdominal pain and recognize children with surgical conditions, scrupulous history taking and numerous physical checkups are mandatory.The most important and realistic first goal in the evaluation of acute AP is to distinguish between surgical and nonsurgical situations, which are further divided into urgent and non-urgent categories. A thorough history and physical examination, laboratory investigations to evaluate comorbidity, and imaging scans are usually used for these purposes. Management decisions should necessitate teamwork between the emergency room physician, a surgeon, and a radiologist. Consecutivereassessment and symptomatic treatment with hardworking follow-up are necessary for management as soon aspossible in urgent disorder.

An audit of inter‐hospital transfers of children with abdominal pain and their associated medical imaging findings

AbstractIntroductionUltrasound is a common first‐line examination in acute abdominal pain in children. In rural and regional areas, ultrasound is an important factor in decisions to transfer paediatric patients for tertiary care. Transfers can be over a considerable distance, by road and air, and at great cost. This audit reviewed ultrasound findings in children transferred to an Australian paediatric hospital for acute abdominal pain.MethodsChildren transferred for acute abdominal pain between July 2018 and June 2019 was identified. Imaging findings at the transferring and receiving facility were reviewed, along with the patient's electronic medical record. Suspected and final diagnoses were recorded, and the accuracy of imaging evaluated.ResultsThere were 172 transfers identified, mean age was 6 years 1 month, 66.3% were boys. Mean transfer distance was 55.4 km. The majority were suspected acute appendicitis (63.9%), followed by intussusception (20.3%), and hypertrophic pyloric stenosis (14.5%). The majority of suspected diagnoses were ultimately false positives including pyloric stenosis, 52.0%; appendicitis, 50.9% and ileo‐colic intussusception, 74.3% of cases negative.ConclusionImproved diagnostic accuracy in evaluating causes of acute paediatric abdominal pain with ultrasound, particularly appendicitis, pyloric stenosis, and intussusception is required. Targeted education and clinical support mechanisms may reduce potentially unnecessary inter‐hospital transfers and their considerable associated costs.

Clinical therapeutic effects of opioid analgesia for acute abdominal pain in children and young adults: A protocol for systematic review and meta-analysis.

Background:Nearly 10% of all patients who visit the emergency department report severe abdominal pain. Out of these, almost one-third are not diagnosed accurately. The conventional practice to care for such inpatients involves actively managed observation and repetitive clinical assessments at regular intervals. The aim of this study is to assess the clinical therapeutic effects of opioid analgesia in the treatment of severe abdominal pain in kids and adolescents.Methods:A comprehensive electronic search will be done on Web of Science, EMBASE, PubMed, WanFang database, Chinese National Knowledge Infrastructure, and the Cochrane Library from their establishment to May 2021. The search will identify and retrieve all randomized controlled trials that describe the clinical therapeutic effects of opioid analgesia to treat severe abdominal pain in adolescents and children. Two independent authors will shortlist studies that meet the inclusion criteria, extract data from selected studies, and evaluate the risk associated with bias in the selected articles. We will use RevMan (v: 5.3) to conduct all the data synthesis.Results:This meta-analysis will conduct a high-quality synthesis on present evidence related to the usage of opioid analgesia to treat severe abdominal pain in both kids and adolescents.Conclusion:Our findings will summarize the present evidence and help judge whether opioid analgesia is an effective and safe line of treatment for severe abdominal pain.Ethics and dissemination:This study will use pre-published data, and as such, it does not require ethics approval.OSF registration number:May 29, 2021.osf.io/fp9ym (https://osf.io/fp9ym/).

Appendicitis in children with acute abdominal pain in primary care, a retrospective cohort study.

General practitioners (GPs) face a diagnostic challenge when assessing acute abdominal pain in children. However, no information is available on the current diagnostic process or the diagnostic accuracy of history and physical examination in primary care settings. To describe the diagnostic process for acute abdominal pain among children in primary care, focusing on appendicitis, and to assess the diagnostic accuracy of individual clinical features. A retrospective cohort study in Dutch primary care, using the Integrated Primary Care Information database. Children aged 4-18 years were included if they had no history of appendicitis and presented with acute abdominal pain during 2010-2016. We evaluated GP management and the diagnostic accuracy of clinical features for appendicitis. Pre- and post-test probabilities were calculated for each clinical feature and compared with the probability of appendicitis after GP assessment. Out of 5691 children, 944 (16.6%) were referred and 291 (5.1%) had appendicitis, of whom 55 (18.9%) were initially misdiagnosed. The pre-test probability (i.e. of appendicitis in evaluated children) varied from 3% (rigidity) to 28% (migratory pain). Concerning post-test probabilities, positive values for rebound pain (32.1%) and guarding (35.8%) and the negative value for right lower quadrant tenderness (0.6%) were superior to overall GP assessment (29.6% and 1.1%, respectively). GP assessment will miss almost one-fifth of children with appendicitis at their first presentation, and about two-third of GP referrals will be negative. The presence of specific signs can increase or decrease the likelihood of appendicitis, emphasising the importance of a physical examination.

Omental Infarction: An Underrecognized Cause of Right-Sided Acute Abdominal Pain in Children.

To evaluate the prevalence of omental infarction (OI) in children with suspected appendicitis, the role of ultrasonography (US) in its diagnosis and management and the efficacy of conservative management. Consecutive children with suspected acute appendicitis were prospectively enrolled. Ultrasonography was performed at baseline, during follow-up, before the discharge, and at 15-day intervals until US findings of OI disappeared. All children with a diagnosis of OI were treated conservatively. One hundred ninety-nine children (91 male; age range, 3-15 years) were evaluated. Eighty-four patients had acute appendicitis. Omental infarctions were found in 14 children (8 male; mean age, 9.8 ± 2.6 years), with an incidence of 7%. Ultrasonography depicted an echogenic mass consistent with OI in all children. Ultrasonography detected in 8 patients a normal-looking appendix, whereas in other 6 patients, it identified neither appendix nor indirect signs of acute appendicitis. A normal appendix has been detected by US during follow-up in 2 of these 6 patients. During follow-up, US finding of OI disappeared in all cases and no signs of acute appendicitis or other disease occurred. All 14 OIs were treated conservatively, with no reported complications. Omental infarction is an underestimated cause of abdominal pain in children accounting for 7% of patients with suspected appendicitis. Ultrasonography is a useful method for the diagnoses and to guide clinical management of OI. Conservative therapy is a safe option for the management of OI.

Not only fat: omental infarction and its mimics in children. Clinical and ultrasound findings: a pictorial review.

Acute abdominal pain in children is the most common cause of emergency department admissions. Omental infarction is a rare cause of acute abdominal pain in this age group, accounting for approximately 15% of cases in children and 0.024-0.1% of cases of surgery for suspected appendicitis at the same age. Its clinical presentation may mimic similar diseases such as acute appendicitis, epiploic appendagitis, and mesenteric panniculitis. Ultrasound is the modality of choice for the initial evaluation of acute abdominal pain in pediatric patients and it can be used with confidence in the diagnosis and management of omental infarction in children. In this brief review, we focus on the main ultrasound findings and their diagnostic clue for omental infarction and its mimics.

Postraumatic Torsion of Wandering Spleen in 9-year-old Boy

Post-traumatic torsion of wondering spleen is extremely rare cause of acute abdominal pain in children with only few cases reported. We report a case of a 9-year-old boy with wandering spleen torsion after bike crash and subacute clinical presentation. After a bicycle crash and a period of persistent fever family physician performed an ultrasound of abdomen which showed a round focal lesion of 10 x 12 cm in size, a spleen-like echogenicity in the middle-lower abdominal position and in the small pelvis, which raised suspicion of ectopic (wandering) spleen. The abdominal MSCT confirmed the diagnosis of wandering spleen, Numerous immunologic, hematological, radiological, infectious, endocrinological, chromosomal and cytological tests and markers confirmed a diagnosis of the splenic malformation. A surgeon arranged to perform splenopexy after checking the vaccination status. Laparotomy was initiated. The splenic artery and vein, which was in a triple twist, was released and due to the resulting path, the spleen itself was larger than the CT finding. The spleen was placed under the left ribs and splenopexy was performed. At the fifteen-day and two-month follow ups, the patient felt good, was painless, afebrile and the spleen gradually decreased. Wondering spleen should be considered as a possible cause of acute abdominal pain when the spleen is not seen in its usual position. The treatment of choice is surgery, with the goal of preservation of the organ whenever possible.

Non specific mesenteric adenitis of forty-five cases in childhood and review

Mesenteric lymphadenitis is a disease that pediatric surgeons face on a daily basis due to symptoms resembling the symptoms of acute appendicitis. 45 children with abdominal pain were examined for the last 3 years, aged 3 to 18 years, treated non-surgically, and proven laboratory, microbiological and instrumental diagnosis. Mesenteric lymphadenitis is a very common diagnosis in children with suspected acute appendicitis. In previous methods, based solely on age and location, there were many difficulties in identifying the etiology of acute abdominal pain in children. We decided to develop a new systematic classification of acute abdominal pain. Carrying out a clinical and epidemiological analysis of the diseased children with acute surgical diseases in order to establish a pre-operative imaging and laboratory diagnosis, to establish the sensitivity of microbiological markers An overview of the literature on the topic has been made

THE COMPARATIVE ANALYSIS OF ALVARADO AND PAS SCALES IN THE DIFFERENTIAL DIAGNOSTICS OF ACUTE ABDOMINAL PAIN IN CHILDREN

Introduction. Current trends in the diagnostics of acute appendicitis have the following main objectives: to improve the diagnostic accuracy in destructive forms; to reduce the number of negative appendectomies and diagnostic laparoscopies. Purpose. To compare the effectiveness of Alvarado and PAS scales and to find out which of them is more appropriate in the differential diagnostics of acute abdominal pain in children. Material and Methods. A prospective randomized blind clinical trial was performed. 326 children aged 5-17 years with abdominal pain were examined. Results. No significant advantages of any of the analyzed scales were found in the differential diagnostics of acute abdominal pain in children aged 5-17 years. Both scales can be used in the primary stratification of patients. With the conclusion “Acute appendicitis is likely possible,” the level of non-diagnosed cases of acute appendicitis will not exceed 3%. Conclusions. Further assessment of various scales for the diagnostics of acute appendicitis in children has to be done in order to select the optimal one. The obtained results urge to make scales’ modification so as to improve the diagnostic accuracy and to reduce the number of negative appendectomies and diagnostic laparoscopies.

Quality of care for acute abdominal pain in children

ObjectiveTo assess quality of care for children presenting with acute abdominal pain using validated indicators.DesignAudit of care quality for acute abdominal pain according to 21 care quality indicators developed and...

Distribution of causes of acute abdominal pain in children that presented to a state hospital radiology unit according to age, gender and pathology origin

Objectives: The term “acute abdomen” refers to any sudden non-traumatic disorder whose chief manifestations are located within the abdominal area. In this condition, urgent operation may be necessary. The aim of this study was to investigate the distribution of causes of acute abdominal pain in children according to their age, gender and origin of pathology, who presented to a state hospital radiology unit in Turkey that had undergone standardised abdominal sonography and computed tomography imaging if necessary. Methods: This study was designed as a retrospective investigation. A sample of 1000 patients (568 males and 432 females) were selected from a pool of 3452 paediatric patients between 2014 and 2016. Results: Acute abdomen in the paediatric age group occurred more frequently in males than females. The most common age of presentation with acute abdominal pain was between 7 and 15 years. The most common medical cause was mesenteric lymphadenitis (11%). In females, mesenteric lymphadenitis, acute appendicitis and ovarian cyst rupture were the predominant causes, whereas mesenteric lymphadenitis, acute appendicitis and urinary system pathologies were predominant in males. Conclusions: When evaluating a child with acute abdominal pain, the most important components include taking a thorough patient history and performing repeated physical examinations. Selective use of appropriate laboratory and radiological investigations may be necessary in order to establish a specific diagnosis.

Clinical spectrum of acute abdomen in children admitted to pediatric emergency department: A prospective study

IntroductionAcute abdominal pain accounts for about 8% of all children attending the emergency department (ED) (Balachandran et al., 2013). In spite of being a common symptom seen in children, it is not uncommon for it to be a manifestation of a serious surgical emergency. There are inadequate published data from India regarding the spectrum of acute abdominal pain in children. ObjectiveThe objective of this study was to assess the clinical profile of children with nontraumatic acute abdominal pain admitted in the pediatric ED. MethodologyThis prospective observational study was conducted between June 2016 and July 2017. All the records of children aged between 2 and 18 years presenting with complaints of abdominal pain were collected in a predesigned proforma at the time of admission in the pediatric ED. Children who had undergone previous abdominal surgery and those with a history of trauma were excluded. ResultsA total of 720 children attending ED with complaints of abdominal pain were seen by the surgical team. According to their final diagnosis, they were divided into two groups: group I, 58 (8%; surgical); group II, 662 (92%; nonsurgical). Mean age of presentation was 7.5 ± 5.7 years; male-to-female ratio was 1.6:1. Detailed history and pain characteristics help in establishing the cause of pain. ConclusionThe cause of pain in more than 90% of children presenting in the pediatric ED with complaints of abdominal pain is nonsurgical. Constipation was the most common diagnosis in these children, followed by acute gastroenteritis. Only in 8% children, the cause of pain is surgical, and acute appendicitis is the most common surgical cause.

The diagnostic value of ischaemia-modified albumin in acute abdominal pain.

The differential diagnosis of paediatric patients admitted to the emergency department presenting with acute abdominal pain may be difficult. This study aims to investigate the diagnostic value of ischaemia-modified albumin (IMA) in the differential diagnosis of acute abdominal pain in children and in distinguishing surgical from non-surgical cases. The study was conducted with a total of 152 subjects who provided informed consent, including 112 patients admitted to the paediatric emergency department and paediatric surgical clinic and 40 healthy control subjects. Blood samples were collected after initial examination to determine IMA, white blood cell (WBC) and C-reactive protein (CRP) values. Mean IMA values of patients with acute appendicitis (AA), perforated appendicitis (PA) and non-specific abdominal pain were significantly higher compared to the control group. Mean IMA values of the AA and PA cases were also significantly higher compared to the group with non-specific abdominal pain. No significant difference was determined in mean IMA between the AA and PA groups. WBC and CRP levels of the AA and PA groups were significantly higher compared to the group with non-specific abdominal pain. Our study shows that IMA, together with WBC and CRP, may be a biomarker capable of assisting the differential diagnosis of acute abdominal pain in children and distinguishing surgical from non-surgical cases.

The isolated tubal torsion: an insidious pediatric and adolescent pelvic urgency.

Isolated tubal torsion (ITT) is a rare cause of acute abdominal pain. Preoperative diagnosis is difficult because of a lack of specific signs. Surgery is recommended to preserve the integrity of the tube. Seven patients of median age of 13 years (range 9 to 15) came to our observation for worsening abdominal pain, nausea and vomiting. On admission, all girls had blood tests and ultrasound. Laparoscopy was performed for diagnosis in all cases. The girls had one-month and one-year ultrasound and clinic follow up. In all cases diagnosis was delayed, median 66 hours after the onset of symptoms and laparoscopy showed necrosis of the Fallopian tube. In five girls a laparoscopic salpingectomy was performed. In the other two, an open salpingectomy was necessary because of pelvic adhesions. Histology showed a hemorrhagic infarction of the Fallopian tubes. At follow up all patients were asymptomatic with normal ovaries, but one ovarian cyst. In the differential diagnosis of acute abdominal pain in children or female adolescents the possibility of ITT should be considered for a conservative treatment. Laparoscopy allows for definitive diagnosis and treatment.

A Rare Cause of Acute Abdominal Pain in Childhood: Peptic Ulcer Perforation

A Rare Cause of Acute Abdominal Pain in Childhood: Peptic Ulcer Perforation

The Diagnostic Value of C-Reactive Protein and Total Leucocytes Count in Patients with Acute Abdominal Pain In Children

The Diagnostic Value of C-Reactive Protein and Total Leucocytes Count in Patients with Acute Abdominal Pain In Children

The Diagnostic Value of C-Reactive Protein and Total Leukocyte Count in Patients with Acute Abdominal Pain In Children.

Background: C-reactive protein (CRP) is one of the acute-phase proteins which increases during inflammatory conditions. Nowadays, C-reactive protein (CRP) is a commonly used biomarker especially in emergency department (ED) for diagnostics of febrile and infectious patients. It is almost impossible to distinguish the bacterial from nonbacterial (viral) infection by CRP level only - so the detailed history of onset of disease is very important to establish the diagnosis of bacterial infection as a cause of acute abdominal pain.Objective: The aim of this study was to establish the diagnostic value of leucocyte and CRP count in in diagnosing acute abdominal pain.Material and methods: We retrospectively evaluated 159 patients with acute abdominal pain admitted to the surgical department of the Clinical Hospital of Tetova and PHO “Alba – Med” over a period of 2 yearsrespectively from January 20016 to January 2018. All patients included in this study was aged between five to 15 years old.Results: During the study period there were 158 patients (96 were females and 56 males). All the patients suffered from acute abdominal pain, whereas 45 of them had a surgical condition, respectively in 42 of them acute appendicitis as a cause of pain, Meckel’s diverticulitis, jejunal intussusception and ruptured ovarian cyst in three other patients. In 105 patients nonsurgical condition was the reason of acute abdominal pain. CRP was performed within 24 h after admission in all the patients. In the group of patients with surgical disease in 41 of them (91 %) the value of CRP was more than > 5g/L.Conclusions: According to our experience we conclude that the CRP level is not sufficient to predict patients with acute abdominal pain that require surgical treatment.

Express Immunochromatographic Detection of Rotavirus and Adenovirus Antigens in Pre-Hospital Differential Diagnosis of Acute Abdominal Pain in Children

Background.The assessment of the condition of a child with acute abdominal pain and a diagnostic search algorithm at the prehospital stage determine the further routing of the patient and the timeliness of healthcare delivery.Objective.Our aim was to evaluate the possibility of using immunochromatographic rapid tests (ICA) to determine the rota- and adenovirus infection in pre-hospital differential diagnosis of abdominal syndrome in children.Methods.In a retrospective cohort study, we analyzed the medical records of patients with a combination of abdominal and intestinal syndromes who applied for medical assistance to the emergency pediatric department of the FSAI “NMRC of Children’s Health” of the Ministry of Health of Russia from January 2015 to December 2017.Results.Outpatient medical records of 201 patients aged from 4 months to 17 years have been analyzed. In patients with a positive ICA, only 6% (5/88) of cases had doubtful or positive symptoms of peritoneal irritation, whereas in the case of a negative rapid test, almost all children needed a surgeon’s consultation. The frequency of leukocytosis detection in a clinical blood test was not different in patients with different results of ICA. The increase of C-reactive protein as a marker of bacterial inflammation was more common in patients with a negative rapid test. The volume of additional diagnostic care in the group of patients with a negative ICA result was significantly higher than in patients with confirmed viral gastroenteritis. None of the children with confirmed viral gastroenteritis required a surgical treatment. In the group with a negative ICA result, surgical treatment was performed in 11% (12/113) cases.Conclusion.Patients with confirmed viral gastroenteritis require significantly fewer diagnostic measures; they also have a minimal probability of acute surgical pathology. The use of laboratory rapid tests at the pre-hospital stage plays an important role in the timely diagnosis and the reduction in the frequency of non-specialized hospitalization.

Acute Abdominal Pain

1. Robert D. Baker, MD, PhD* 1. *Department of Pediatrics, Digestive Disease and Nutrition Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, The State University of New York, Buffalo, NY * Abbreviations: CRP: : C-reactive protein CT: : computed tomography DRE: : digital rectal examination ERCP: : endoscopic retrograde cholangiopancreatography GI: : gastrointestinal HIDA: : hydroxyiminodiacetic acid IV: : intravenous MRI: : magnetic resonance imaging TPN: : total parenteral nutrition WBC: : white blood cell Children frequently have acute abdominal pain. The physician must identify which child has a potentially catastrophic condition (<2%). Because the number of patients requiring immediate action is low, the physician can be lulled into a sense of safety. Infrequently, acute abdominal pain can be catastrophic, so the physician needs to be cognizant of conditions requiring action. Knowledge and judgment are key. After completing this article, readers should be able to: 1. Understand the causes and frequency of acute abdominal pain in childhood. 2. Develop a differential diagnosis based on age and symptoms. 3. Formulate a plan for evaluation and management of acute abdominal pain. 4. Choose the appropriate imaging study for various diagnoses. Acute abdominal pain is a frequent and challenging problem facing pediatricians. The cause of acute abdominal pain can range from John Apley’s “little bellyacher” (1) to an emergency requiring immediate action. Assessing acute abdominal pain is a situation that requires excellent clinical acumen, an area where pediatricians should “prove their worth” by outperforming other primary caregivers. Making the correct diagnosis may earn the pediatrician accolades for saving a life (as in the case of intussusception or midgut volvulus) but may also not win friends (as when a mother is informed that the reason for her child’s excruciating pain is constipation). A mistaken diagnosis can have devastating results, either by not acting when action is called for or by performing unnecessary tests and procedures. Because the differential diagnosis list for acute abdominal pain is long, a logical approach is to consider diagnoses by age group. Convenient age divisions …

Primary Peritonitis in Immunocompetent Children

Primary peritonitis is defined as peritoneal infection without an evident intra peritoneal septic focus. In the absence of these conditions, primary peritonitis is exceptional, and only few cases were reported in the literature. Here we report two cases of primary peritonitis in immunocompetent children. Although rarely encountered, primary peritonitis should be included in the differential diagnosis of acute abdominal pain in children.