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Common abdominal emergencies in children
1Department of Emergency Medicine, State University of New York, Upstate Medical University, Syracuse, New York, USA. dagostinj@upstate.edu
Insights
Emergency physicians must suspect serious abdominal emergencies in children, even with vague symptoms. Careful history, physical exams, and repeated observations are key for accurate pediatric abdominal pain diagnosis.
Area of Science:
- Pediatric Emergency Medicine
- Gastrointestinal Emergencies in Children
Background:
- Young children frequently present to emergency departments (EDs) with abdominal complaints.
- Differentiating serious abdominal emergencies from less severe causes like constipation or gastroenteritis is crucial.
Purpose of the Study:
- To emphasize the importance of a high index of suspicion for serious pediatric abdominal emergencies.
- To highlight the diagnostic value of history, physical examination, and observation in pediatric abdominal pain.
Main Methods:
- Thorough and complete history taking from parents and children.
- Gentle yet comprehensive physical examinations.
- Repeated examinations and patient observation.
Main Results:
- Ancillary tests, including abdominal radiographs, can be unreliable in diagnosing pediatric abdominal emergencies.
- Pediatric appendicitis may present with non-specific symptoms like lethargy or poor feeding.
- Intussusception can present with intermittent symptoms, with children appearing playful between episodes.
Conclusions:
- Emergency physicians must maintain a high index of suspicion for serious pathology in pediatric patients with abdominal complaints.
- Patience, repeated examinations, and careful observation are essential for accurate diagnosis of pediatric abdominal emergencies.
Abstract:
Because young children often present to EDs with abdominal complaints, emergency physicians must have a high index of suspicion for the common abdominal emergencies that have serious sequelae. At the same time, they must realize that less serious causes of abdominal symptoms (e.g., constipation or gastroenteritis) are also seen. A gentle yet thorough and complete history and physical examination are the most important diagnostic tools for the emergency physician. Repeated examinations and observation are useful tools. Physicians should listen carefully to parents and their children, respect their concerns, and honor their complaints. Ancillary tests are inconsistent in their value in assessing these complaints. Abdominal radiographs can be normal in children with intussusception and even malrotation and early volvulus. Unlike the classic symptoms seen in adults, young children can display only lethargy or poor feeding in cases of appendicitis or can appear happy and playful between paroxysmal bouts of intussusception. The emergency physician therefore, must maintain a high index of suspicion for serious pathology in pediatric patients with abdominal complaints. Eventually, all significant abdominal emergencies reveal their true nature, and if one can be patient with the child and repeat the examinations when the child is quiet, one will be rewarded with the correct diagnosis.