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Clinical features of abdominal painful crisis in sickle cell anemia
1Department of Pediatrics, Medical College of Wisconsin, Milwaukee.
Insights
Children with sickle cell anemia experiencing abdominal painful crisis (APC) often present with non-surgical symptoms. Early observation after outpatient treatment is recommended for suspected APC to monitor for serious abdominal conditions.
Area of Science:
- Pediatric Hematology
- Gastroenterology
- Clinical Medicine
Background:
- Sickle cell anemia (SCA) is a genetic blood disorder.
- Abdominal Painful Crisis (APC) is a common complication in children with SCA.
- Differentiating APC from surgical abdominal conditions is crucial for appropriate management.
Purpose of the Study:
- To delineate the clinical characteristics of abdominal painful crisis (APC) in children with sickle cell anemia (SCA).
- To identify features that distinguish APC from a "surgical" abdomen in pediatric SCA patients.
Main Methods:
- Retrospective review of medical records.
- Analysis of 106 cases of APC in 43 children over a 4-year period.
- Evaluation of presenting symptoms and physical examination findings.
Main Results:
- Most children with SCA and APC did not present with vomiting.
- Physical findings typically included normoactive bowel sounds and a nonrigid abdomen.
- Absence of involuntary guarding or rebound tenderness was common, unlike in surgical abdomens.
Conclusions:
- Clinical presentation of APC in pediatric SCA differs from traditional surgical abdomen findings.
- Children with suspected APC showing initial improvement with outpatient analgesia require hospitalization for observation.
- Monitoring for symptom recurrence or progression is essential to rule out surgical abdominal disease.
Abstract:
A retrospective review of children having sickle cell anemia and abdominal painful crisis (APC) was performed in order to delineate the pattern of their presenting clinical characteristics. Of 43 children accounting for 106 cases of APC that occurred during a 4-year period, 94 cases involved a child who had had a previous episode of APC. Symptoms included vomiting (10) and concomitant bone or joint pain (42). Physical findings showed 98 children with normoactive bowel sounds, 96 with a nonrigid abdomen to palpation, two with involuntary guarding, and two with rebound tenderness. Certain clinical characteristics are useful in distinguishing children with sickle cell anemia and APC. As compared with traditional findings that suggest a "surgical" abdomen, most of the children who have sickle cell APC do not experience vomiting, and present with normoactive bowel sounds, nonrigid abdomen, and absence of involuntary guarding or rebound tenderness. Children having presumed APC who receive analgesic medication in an outpatient setting with symptomatic improvement should be hospitalized for observation to monitor for recurrence/progression of symptoms indicative of an abdominal disease process requiring surgery.