Dr Ira Shah

1
Abdominal pain is one of the most common
presentations in the pediatric emergency
department. The most important concern is to
decide if the condition requires surgical
intervention or can be managed medically. What
is important is to note whether the pain is
constant or colicky and the site and radiation of
pain. Also, other associated features such as
nausea, vomiting, bowel or urinary complaints,
vaginal bleeding aid in the diagnosis. Clinical
examination findings such as presence of fever,
tenderness, rigidity (indicates peritoneal
inflammation), organomegaly, increased/decreased
bowel sounds, pallor, jaundice usually helps to
determine the cause of pain. Causes of acute
abdomen In first few years of life 1.
Congenital abnormalities 2. Incarcerated
inguinal hernia 3. Intussuception 4.
Intestinal volvulus 5. GI perforation 6. NEC
in preterm neonates In older children
1.Trauma 2. Pancreatitis 3. Meckels
diverticulum 4. Primary peritonitis 5.
Intestinal worm infestation In adolescents
1. Acute appendicitis 2. Cholecystitis
(acalculous) 3. Testicular torsion 4. Rupture
of ovarian cyst Non- surgical causes of
abdominal pain 1. Hyperthyroidisin 2.
Addisons disease 3. Diabetic ketoacidosis 4.
Hypercalcemia 5. Lead poisoning 6. Porphyria
Non-specific abdominal pain It is the most
common cause of abdominal pain in late childhood
and early adolescence. It is a colicky pain with
some localization that becomes worse after meals.
Bowel sounds may be increased and a palpable
mass of feces may be present in right or left
iliac fossa. The causes commonly are
constipation, irritable bowel and chronic spasm.

2
The treatment consists of antispasmodics.
Investigations in a child with acute abdomen
1. Abdominal X-Ray/Chest X-Ray erect Look for
bowel obstruction calcification, free air and
lower lobe pneumonia. Also soft tissue mass may
be seen 2. Ultrasound of both pelvis and upper
abdomen For hepatobiliary, renal and
gynaecological pathology.
3. Complete blood count Increased in case of
necrosis, bacterial infection, abscess 4.
Peripheral smear for HUS, Sickle cell. 5. Urine
examination for UTI, porphyria Additional
investigations Serum Amylase/lipase for
pancreatitis Blood cultures Beta HCG
CT scan for abdomen Stool examination
for worm infestation Typical presenting
clinical characteristics of common abdominal
disorders in infants and children
3
Management of acute abdomen Along with
treatment of the specific conditions, patients
may require intravenous fluids, antibiotics and
antispasmodics. The commonly used antibiotics are
ampicillin (100 mg/kg/d), gentamicin (5
mg/kg/d), clindamycin (40 mg/kg/d) or
metronidazole (30 mg/kg/d). Other antibiotics
such as third generation cephalosporins are also
useful. Surgical treatment would depend on the
presenting cause.