Managing acute abdominal pain in pediatric patients: current perspectives
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Published on: July 7, 2023
Nadia M Hijaz1, Craig A Friesen1
1Division of Gastroenterology, Hepatology, and Nutrition, Children's Mercy Kansas City, Kansas City, MO, USA.
Insights
Diagnosing acute abdominal pain in children is challenging due to vague symptoms. A structured approach differentiating urgent surgical from non-surgical causes is key to timely treatment and avoiding unnecessary procedures.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Surgery
- Emergency Medicine
Background:
- Acute abdominal pain is common in children but challenging to diagnose.
- Nonspecific symptoms and examination difficulties complicate pediatric abdominal pain assessment.
- Timely diagnosis is crucial to differentiate benign conditions from urgent surgical or medical emergencies, balancing treatment needs with radiation exposure and unnecessary operations.
Purpose of the Study:
- To outline a diagnostic strategy for acute abdominal pain in pediatric patients.
- To differentiate urgent surgical from non-surgical conditions.
- To guide initial testing and management, emphasizing timely diagnosis and appropriate treatment.
Main Methods:
- Review of clinical features, including patient age and history.
- Focused physical examination for serious conditions.
- Consideration of laboratory tests and imaging studies.
- Emphasis on differentiating urgent vs. non-urgent surgical and non-surgical causes.
Main Results:
- A systematic approach is proposed to differentiate surgical from non-surgical causes of abdominal pain.
- Key historical features, physical examination findings, and appropriate tests are highlighted.
- Initial testing and management strategies are discussed, including consultations and follow-up.
Conclusions:
- A structured diagnostic approach is essential for managing pediatric acute abdominal pain.
- Differentiating urgent surgical conditions early prevents diagnostic delays and morbidity.
- Consultation with specialists and thorough reevaluation are vital for optimal patient outcomes.
Abstract:
Acute abdominal pain in pediatric patients has been a challenge for providers because of the nonspecific nature of symptoms and difficulty in the assessment and physical examination in children. Although most children with acute abdominal pain have self-limited benign conditions, pain may be a manifestation of an urgent surgical or medical condition where the biggest challenge is making a timely diagnosis so that appropriate treatment can be initiated without any diagnostic delays that increase morbidity. This is weighed against the need to decrease radiation exposure and avoid unnecessary operations. Across all age groups, there are numerous conditions that present with abdominal pain ranging from a very simple viral illness to a life-threatening surgical condition. It is proposed that the history, physical examination, laboratory tests, and imaging studies should initially be directed at differentiating surgical versus nonsurgical conditions both categorized as urgent versus nonurgent. The features of the history including patient's age, physical examination focused toward serious conditions, and appropriate tests are highlighted in the context of making these differentiations. Initial testing and management is also discussed with an emphasis on making use of surgeon and radiologist consultation and the need for adequate follow-up and reevaluation of the patient.
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