Contemporary management of abdominal surgical emergencies in infants and children
L W E van Heurn1, M P Pakarinen, T Wester
1Departments of Paediatric Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
Insights
Acute abdomen in children presents unique challenges. Early diagnosis and treatment, utilizing advanced imaging and minimally invasive surgery, are crucial for effective management in pediatric emergency care.
Area of Science:
- Pediatric Surgery
- Emergency Medicine
- Diagnostic Imaging
Background:
- Acute abdominal complaints are frequent in pediatric emergency departments.
- Etiology, presentation, diagnosis, and management in children differ from adults.
Purpose of the Study:
- To review the diagnosis and management of acute abdominal emergencies in children.
- To highlight the importance of specific presentations, imaging, and surgical techniques.
Main Methods:
- Expert pediatric surgical experience.
- Literature review of PubMed and Cochrane Library.
- Inclusion of reviews, RCTs, meta-analyses, and cohort studies on pediatric abdominal emergencies.
Main Results:
- Pediatric abdominal emergency presentations vary widely, complicating diagnosis and treatment.
- Targeted imaging techniques are vital for timely and accurate diagnosis.
- Minimally invasive techniques are preferred for diagnosis and treatment.
Conclusions:
- Understanding childhood abdominal disorders is key for emergency management.
- Imaging and minimally invasive procedures are increasingly important for diagnosing acute abdomen in children.
- Urgent surgery remains central to treating most acute abdominal conditions in pediatric patients.
Background:
Acute abdominal complaints in children are common presentations in the emergency department. The aetiology, presentation, diagnosis and management often differ from those in adults.
Methods:
This review was based on expert paediatric surgical experience confirmed by evidence from the literature obtained by searching PubMed and the Cochrane Library. Keywords used were the combinations of 'abdominal emergencies', 'acute abdomen' and the disorders 'acute appendicitis', 'intussusception', 'volvulus', 'Meckel's diverticulum', 'incarcerated inguinal hernia', 'testicular torsion' and 'ovarian torsion' with 'children'. Information was included from reviews, randomized clinical trials, meta-analyses, and prospective and retrospective cohort studies.
Results:
Presentation and symptoms of abdominal emergencies, especially in young children, vary widely, which renders recognition of the underlying disorder and treatment challenging. Critically targeted imaging techniques are becoming increasingly important in obtaining the correct diagnosis without unnecessary delay. Minimally invasive techniques have become the method of choice for the diagnosis and treatment of many abdominal emergencies in children.
Conclusion:
Knowledge of abdominal disorders in childhood, their specific presentation, diagnosis and treatment facilitates management of children with acute abdomen in emergency departments. Imaging and minimally invasive techniques are becoming increasingly important in the diagnosis of acute abdomen in children. Urgent operation remains the cornerstone of therapy for most acute abdominal disorders.
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