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Acute Abdominal Pain: Recognition and Management of Constipation in the Emergency Department
Stefania Norbedo1, Giulia Bassanese, Francesca Barbieri
1From the *Institute for Maternal and Child Health-IRCCS "Burlo Garofolo"; and †University of Trieste, Trieste, Italy.
Insights
Functional constipation affects a quarter of pediatric patients with acute abdominal pain. Medical history is key for diagnosis, and enemas offer prompt relief, avoiding unnecessary tests.
Area of Science:
- Pediatric Gastroenterology
- Emergency Medicine
Background:
- Acute abdominal pain is a common pediatric emergency department complaint.
- Functional constipation is a frequent, yet often overlooked, cause of abdominal pain in children.
Purpose of the Study:
- To determine the incidence of functional constipation in children presenting with acute abdominal pain.
- To identify key clinical features associated with functional constipation in this population.
Main Methods:
- Retrospective analysis of 4394 medical records of pediatric patients admitted for acute abdominal pain.
- Data collection included demographics, symptoms, medical history, physical examination, and diagnostic/treatment strategies.
Main Results:
- Functional constipation was diagnosed in 25% (1020/4394) of patients.
- Pain was typically moderate to severe; location was not diagnostic. Isolated vomiting occurred in a minority.
- Enemas provided prompt relief; digital rectal exploration and radiography were rarely employed.
Conclusions:
- Medical history is crucial for diagnosing functional constipation in pediatric emergency settings.
- Enemas serve as effective diagnostic and therapeutic tools.
- Avoidance of digital rectal exploration and radiography is recommended.
Objective:
The main aim of the study was to investigate the incidence and the clinically relevant features of functional constipation in patients evaluated for acute abdominal pain in a tertiary care pediatric emergency department.
Methods:
This is a retrospective study. We analyzed 4394 medical records and recorded the information (demographics, triage code, symptoms, medical history, physical evaluation, laboratory tests, radiological studies, procedures, and treatments) of all patients admitted for acute abdominal pain to the emergency department of the IRCCS Burlo Garofolo, Trieste, during 2010 to 2013.
Results:
In this study, a quarter of patients (1020) presenting in the emergency department with acute abdominal pain were affected by functional constipation. Acute pain associated with functional constipation is generally rated from moderate to severe, and the location of the pain on physical evaluation was not a sufficient criterion to guide diagnosis. Isolated vomiting may be present in a minority of cases. Digital rectal exploration was never performed; the majority of patients were treated by means of an enema with prompt relief. Six percent of patients with constipation underwent radiological studies.
Conclusions:
This study confirms that the medical history provides a pivotal role in the diagnosis of functional constipation. Digital rectal exploration and x-rays should be avoided in this setting, whereas an enema plays a useful diagnostic and therapeutic role in our study patients.
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