Acute Abdominal Pain In Children Research Articles

The Society for Pediatric Radiology Magnetic Resonance Imaging and Emergency and Trauma Imaging Committees' consensus protocol recommendation for rapid MRI for evaluating suspected appendicitis in children.

The imaging evaluation of acute abdominal pain in children with suspected appendicitis has evolved to include rapid abdominopelvic MRI (rMRI) over recent years. Through a collaborative effort between the Magnetic Resonance Imaging (MRI) and Emergency and Trauma Imaging Committees of the Society for Pediatric Radiology (SPR), we conducted a survey on the utilization of rMRI to assess practice specifics and protocols. Subsequently, we present a proposed consensus rMRI protocol derived from the survey results, literature review, and discussion and consensus between committee members.

Infarcted accessory liver lobe in a pediatric patient: A case report

Accessory liver lobe (ALL) is a rare abnormality of the liver that occurs during the third week of pregnancy due to the division of the hepatic bud and distortion of the endodermal caudal foregut. ALLs are typically asymptomatic. However, they can become twisted and cause acute abdominal pain. There have been 24 reported cases of ALL torsion in children, most of which required urgent surgical removal. A seven-year-old boy presented to the emergency room with one day of abdominal pain in the epigastric and right hypochondrium areas. Upon physical examination, localized rigidity was observed in the upper hemiabdomen, CT scan revealed a mass originating from the liver. Based on the clinical examination and the CT findings a diagnosis of acute abdomen was made and the patient underwent an emergency laparotomy. During the operation, a mass was found to be connected to the liver through a twisted pedicle. The pedicle was transected, and the mass completely removed. The histopathology report confirmed that the mass was an infarcted ALL and ruled out thrombosis or a neoplasm. Postoperatively the patient developed a bile leak at the base of the transected ALL pedicle, which was managed with a Roux-en-Y hepaticojejunostomy. Making a definitive diagnosis of ALL before surgery may be difficult, even with advanced imaging. Pediatric surgeons should include ALL torsion in the differential diagnosis of acute abdominal pain in children when a mass adjacent to the liver is found on the preoperative images.

Atypical Ovarian Tumor: Mixed Sertoli–Leydig Cell Tumor of Retiform Variant with Focal Heterologous Elements

ABSTRACT Ovarian torsion is an uncommon cause for acute abdominal pain in children while the possibility of malignancy presenting as ovarian torsion is even rarer. We report here an atypical case of ovarian neoplasm presenting as ovarian torsion in a 5-year-old child. The highlight of this case is the epithelial component staining positive for both CK 7 and CK 20 in addition to Sertoli–Leydig cell component indicating it as mixed Sertoli–Leydig cell tumor of retiform variant with focal heterologous elements. The heterologous element is the CK7 and 20 being positive epithelium. The ovarian torsion should make one suspect malignancy in and around the ovary and subject it for detailed histopathologic study and manage accordingly; lest, one’s failure to suspect the same may compromise patient management and prognosis.

Peritonitis primaria por neumococo en un hospital pediátrico de Argentina

Pneumococcal peritonitis represents a small subset of patients suffering from invasive pneumococcal disease (IPD). We describe 5 cases of primary peritonitis documented in the pediatric hospital over 15 years (2005-2020) of IPD surveillance. The patients, 3girls and 2boys with a mean age of 5 years, experienced peritoneal signs and symptoms; 3of them suffered from nephrotic syndrome. Based on the local resistance profiles, all isolates were sensitive to beta-lactams, one strain showed resistance to cotrimoxazole and tetracycline while another strain, to cotrimoxazole only. Serotypes found in 4/5 strains (one was non-viable) were: 1, 19F, 15C and 23A. Children were treated with third-generation cephalosporins or ampicillin, gentamicin and metronidazole and all of them evolved favorably. Pneumococcal etiology should be included in the differential diagnosis of acute abdominal pain in children. Our study aims to contribute to the knowledge of this condition and to the local epidemiology of IPD.

Evaluation of systemic immune-inflammation index efficacy in predicting complicated appendicitis in pediatric emergency department.

Acute appendicitis (AA) is one of the most important causes of acute abdominal pain in children who are admitted to the pediatric emergency department. This study aims to determine the usefulness of the systemic immune-inflammation index (SII) in predicting complicated appendicitis (CA) in pediatric patients. The patients who underwent surgery with the diagnosis of AA were evaluated retrospectively. AA and control groups were formed. AA was divided into noncomplicated and CA groups. C-reactive protein (CRP), white blood cell (WBC) count, absolute neutrophil count (ANC), absolute lymphocyte count, neutrophil/lymphocyte ratio (NLR), platelet (PLT)/lymphocyte ratio (PLR), and SII values were recorded. The SII was calculated with the formula of PLT count × neutrophil/lymphocyte. The efficacy of biomarkers in predicting CA was compared. Our study included 1072 AA and 541 control patients. There were 74.3% of patients in the non-CA (NCA) group and 25.7% in the CA group. CRP, WBC count, ANC, NLR, PLR when AA and control group, complicated and NCA groups are compared in terms of laboratory parameters and SII level AA and it was higher in the CA group. While the SII value was 2164.91±1831.24 in the patients with NCA and 3132.59±2658.73 in those with CA (P<0.001). When the cut-off values were determined according to the area under the curve, CRP and SII were found to be the best biomarkers in predicting CA. Inflammation markers together with clinical evaluation may be useful in distinguishing noncomplicated and complicated AA. However, these parameters alone are not sufficient to predict CA. CRP and SII are the best predictors of CA in pediatric patients.

Neuroparalytic snake bite masquerading as acute abdominal pain in children

Background: Neurotoxic snakebite (usually by the krait) presents with abdominal colic and chest pain as a common premonitory sign of envenomation. Being a nocturnal snake, the time of unprovoked painless biting is usually at night and the victims are individuals sleeping on the ground. Thus, history is usually not forthcoming. Snakebite causes morbidity (neuroparalytic, myopathic, vasculopathic, venom-induced consumption coagulopathy, cardiotoxic, nephrotoxic, etc.), and mortality if not given timely treatment with anti-snake venom (ASV), the only specific treatment. Clinical Description: We present four children from a rural background who were admitted successively over a month during the last rainy season. They initially became symptomatic with acute abdominal pain from midnight to early morning time and developed neuroparalytic manifestations within a few hours. On exclusion of other causes by clinical evaluation, we suspected snakebite envenomation though there was no witnessing of the event or evidence of fang bites. Investigations to rule out commonly associated organ dysfunction were ordered. Management: All children were given supportive therapy. Three cases required mechanical ventilation. The first two received ASV relatively late as the suspicion of snakebite was not considered initially. In the third case, the administration of ASV was early and the hospital stay was shorter. The fourth case received ASV at a peripheral health center and was referred in case he required ventilator support. However, his neuroparalysis did not progress to respiratory failure and he was discharged the earliest. Conclusions: Clinicians should consider snakebite in children belonging to rural areas who present with acute abdominal pain during the rainy season, and monitor for signs of neurotoxicity and other clinical manifestations of snake envenomation. A high index of suspicion should be kept, as definitive treatment with ASV results in early recovery without any sequelae, and reduces mortality.

КЛИНИЧЕСКОЕ ЗНАЧЕНИЕ ПОЛИМОРФНОЯДЕРНЫХ НЕЙТРОФИЛОВ В СТРАТИФИКАЦИИ ДЕТЕЙ С ОСТРОЙ БОЛЬЮ В ЖИВОТЕ

Background. Acute abdominal pain in children is defined as acute pain of non-traumatic genesis lasting up to 5-7 days, and presents a serious diagnostic and tactical problem. Many aspects of diagnosis and treatment remain controversial. Aim. To determine the clinical significance of polymorphonuclear neutrophil count in the stratification of children with acute abdominal pain. Material and Methods. A prospective randomized blind clinical trial was performed. The results of examination and treatment of 633 children admitted to Grodno Regional Children's Clinical Hospital with acute abdominal pain were analyzed. The number of polymorphonuclear neutrophils was analyzed in relative (PNRV) and absolute (PNAV) values. Statistics included evidence-based criteria, ROC and precision-recall curve analysis, Kullback's measure of informativeness (Jxi), Bayes' theorem. Results. Separation points were determined for the PNRV and PNAV tests. It was 65% for the PNRV test and 8.952×109/L for the PNAV test. For PNRV values less than 65%, the probability of acute appendicitis (AA) as a cause of acute abdominal pain was 1.8% (CI 0.2 to 3.4); the overall informative value was 2.94. With PNAV test values less than 6.5×109/L, the probability of AA was 1.2% (CI 0.03 to 2.4%); the overall informative value was 5.24. It was demonstrated that an increase in test values above the indicated values did not significantly increase the probability of AA as a cause of acute abdominal pain in children. Conclusion. The tests studied are highly informative and can be used to stratify patients with acute abdominal pain. It is necessary to validate the results obtained taking into account the specific capabilities of a given medical institution and the type of equipment used.

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.

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.

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.

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

Diagnosing and managing acute abdominal pain in children.

Acute abdominal pain is a common complaint in children. The care of these patients is challenging for clinicians because presentation, diagnosis, and treatment are different in children than adults. This article describes the presentation, physical examination, diagnosis, and treatment of common causes of acute abdominal pain in children and discusses emerging trends in diagnosis and treatment.

Efficacy of Prednisone in Children with Acute Nonspecific Mesenteric Lymphadenitis: A Pilot Study.

Acute nonspecific mesenteric lymphadenitis (ANML) is a common cause of acute abdominal pain in children with no specific treatment. A total of 13 patients (6 boys, 7 girls) aged 7.3 (5-13.5) years with severe acute abdominal pain were evaluated using ultrasonography and laboratory tests to establish the diagnosis of ANML. They were treated with prednisone 1 mg/kg (max 40 mg daily) for a maximum of 5 days. The intensity of abdominal pain was evaluated before and after treatment using a numeric rating scale. All patients had pain scores above 6/10 before, and below 4/10 after treatment with prednisone. Intensity of abdominal pain after treatment for 1-5 days decreased significantly (p &lt; 0.001), with no recurrence at follow-up within 3 months. All other pre-existing signs and symptoms, such as nausea, vomiting, anorexia, fever, diarrhea, and constipation were found to disappear with no adverse effects of corticosteroid therapy. These results suggest that the treatment with prednisone in selective patients with ANML can reduce the duration of abdominal pain.

Acute abdominal pain and nephrotic syndrome: pediatric case reports and review of the literature

BackgroundAcute abdominal pain in nephrotic syndrome (NS) is a well-known clinical symptom and is mainly related to peritonitis. The presence, although rare, of red umbilicus may guide the diagnosis as a suggestive sign of peritonitis also in the non-neonatal period. Instead, the association between intussusception and NS is quite limited. We reviewed all published cases in the literature, and to our knowledge, this is one of the few pediatric cases of spontaneous resolution of intussusception in the setting of NS. Finally, a review of the causes of abdominal pain during the course of NS was made.Cases presentationWe report two pediatric patient cases who complained of acute abdominal pain during a relapse episode of their NS. The first case is a 4-year-old boy with NS (fourth relapse) who presented with acute abdominal pain, ascites, and red umbilicus. Our suspect of primary peritonitis was clinically confirmed because of the subsequent appearance of the classical peritoneal signs. The second case is a 4-year-old boy who developed an ileo-ileal intussusception during the treatment of his first NS relapse, with spontaneous reduction.ConclusionsGastrointestinal disorders are frequently encountered in the course of NS. The appearance of acute abdominal pain in children with NS requires quick management, both clinical and instrumental. A multidisciplinary team approach needs to be encouraged to lead to an accurate diagnosis and a correct treatment.

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/).