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Abdominal surgical emergencies in infants and young children

Maureen McCollough1, Ghazala Q Sharieff

  • 1Department of Emergency Medicine, Keck School of Medicine, University of Southern California, 1200 North State Street, Room G1011, Los Angeles, CA 90033, USA. mmccoll@ucla.edu

Emergency Medicine Clinics of North America
|January 8, 2004
PubMed

Insights

Pediatric surgical emergencies, like bowel obstruction or intussusception, can be subtle. Early diagnosis in ill-appearing children with abdominal pain is crucial for timely intervention and improved outcomes.

Area of Science:

  • Pediatric Surgery
  • Emergency Medicine
  • Gastroenterology

Background:

  • Children may not communicate symptoms effectively, leading to missed surgical emergencies.
  • Prompt recognition of specific signs and symptoms is vital for accurate pediatric diagnoses.

Purpose of the Study:

  • To enhance emergency physicians' awareness of subtle surgical emergencies in children.
  • To provide a diagnostic framework for evaluating pediatric patients with abdominal pain and vomiting.

Main Methods:

  • Review of common and uncommon pediatric surgical emergencies.
  • Emphasis on clinical presentation, diagnostic clues, and immediate management.

Main Results:

  • Ill-appearing children with abdominal pain and vomiting require consideration of ischemic or necrotic bowel (e.g., volvulus, intussusception, necrotizing enterocolitis).
  • Bilious vomiting in infants suggests high bowel obstruction (e.g., midgut volvulus), necessitating surgical consultation.
  • Rectal bleeding patterns (painful vs. painless, associated vital signs) aid in differentiating causes like intussusception, Meckel's diverticulum, or upper GI bleeds.
  • Genital examination is essential to rule out conditions like incarcerated hernia or testicular torsion.

Conclusions:

  • Awareness of specific entities aids in early diagnosis of pediatric surgical emergencies.
  • A high index of suspicion for serious intra-abdominal pathology is warranted in symptomatic children.
  • Timely surgical consultation is critical for conditions presenting with bilious vomiting or significant rectal bleeding.

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