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Demonstration of Cutaneous Allodynia in Association with Chronic Pelvic Pain
Published on: June 23, 2009
Recurrent severe abdominal pain in the pediatric patient
James L Homme1, Ashley A Foster2
1Department of Pediatrics and Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
Insights
Ureteropelvic junction obstruction (UPJO) can cause recurrent abdominal pain in children. Prompt diagnosis with imaging and definitive treatment with open pyeloplasty are crucial for symptom resolution.
Area of Science:
- Pediatric Urology
- Diagnostic Imaging in Pediatrics
- Emergency Medicine
Background:
- Ureteropelvic junction obstruction (UPJO) is a common cause of urinary tract obstruction.
- Pediatric UPJO can present as recurrent abdominal pain, posing a diagnostic challenge in the emergency department (ED).
Observation:
- Two pediatric cases of UPJO presenting with recurrent abdominal pain to the ED are detailed.
- Initial presentations were misdiagnosed, highlighting the need for increased clinical suspicion.
Findings:
- Ultrasound (US) and computed tomography (CT) with diuretic administration were key in diagnosing UPJO.
- Diuretic-enhanced imaging can reproduce symptoms, aiding diagnosis.
Implications:
- UPJO should be considered in pediatric patients with unexplained recurrent abdominal pain.
- Advanced imaging like CT, MRI urography, or diuretic scintigraphy is often necessary for confirmation.
- Open pyeloplasty by a urologist offers definitive treatment for UPJO.
Background:
Ureteropelvic junction obstruction (UPJO) is a blockage occurring at the junction of the ureter and the renal pelvis. Pediatric patients with UPJO pose a diagnostic challenge when they present to the emergency department (ED) with severe recurrent abdominal pain if there is not a level of suspicion for this condition.
Objectives:
Our aim was to review presentation of UPJO to the ED, methods of diagnosis, and treatment of this common but often overlooked condition.
Case Report:
We report on 2 patients, a 9-year-old and 3-year-old, who had multiple presentations to health care providers and the ED with intermittent and recurrent abdominal pain. Subsequent testing, including ultrasound (US) and computed tomography (CT) with diuretic-recreated symptoms, revealed UPJO. Open pyeloplasty was performed, resulting in complete resolution of symptoms.
Conclusions:
UPJO is an important diagnosis to consider when patients present to the ED with recurrent abdominal pain. US can be helpful in suspecting the diagnosis, but often CT, magnetic resonance urography, or diuretic scintigraphy is required for confirmation. Diuretics can be used to aid diagnostic testing by reproducing abdominal pain at the time of imaging. Referral to a urologist for open pyeloplasty is definitive treatment for this condition.
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