Abdominal pain (peds)

For adult patients see Abdominal pain

Background

• Bilious emesis is a surgical emergency until proven otherwise

Clinical Features

• Abdominal pain
• May be associated with nausea, vomiting or diarrhea
• Fever may be present in pain from infectious etiology

Differential Diagnosis

Pediatric Abdominal Pain

0–3 Months Old

• Emergent
  • Necrotizing Enterocolitis
  • Volvulus
  • Testicular torsion
  • Inguinal hernia
    • Incarcerated hernia
  • Trauma
  • Pyloric stenosis
  • Toxic megacolon
  • Hirschsprung's Disease
• Nonemergent
  • Constipation
  • Acute Gastroenteritis
  • Colic

3 mo–3 y old

• Emergent
  • Intussusception
  • Testicular Torsion
  • Trauma
  • Volvulus
  • Appendicitis
  • Toxic megacolon
  • Vaso-occlusive crisis
• Nonemergent
  • Acute Gastroenteritis
  • Constipation
  • Urinary tract infection
  • Henoch-Schonlein purpura

3 y old–adolescence

• Emergent
  • Appendicitis
  • DKA
  • Vaso-occlusive crisis
  • Toxic ingestion
  • Testicular Torsion
  • Ovarian Torsion
  • Ectopic Pregnancy
  • Trauma
  • Toxic megacolon
  • Inflammatory bowel disease
  • Gastric ulcer disease
  • Ovarian cyst
  • Pregnancy
  • Pancreatitis
  • Cholecystitis
  • Intussusception (to age 6)
• Nonemergent
  • Constipation
  • Acute Gastroenteritis
  • Nonspecific viral syndrome
  • Streptococcus pharyngitis
  • Urinary tract infection
  • Pneumonia
  • Renal Stone
  • Henoch-Schonlein purpura
  • Inflammatory bowel disease
  • Vulvovaginitis

Evaluation

Depends on location and history

• Consider:
  • Urinalysis, hCG
  • CBC
  • Chemistry
• Possible imaging:
  • Ultrasound
    • Appropriate for intussusception, ovarian/testicular, gallbladder, IUP, appendicitis
  • CT
    • May be associated with 1/1,000 lifetime risk of malignancy

Abd xray

Abdominal plain xray films are specific, but not sensitive. As such, they have very little utility in the workup of pediatric abdominal pain, unless concerned for a foreign body. Do NOT use films to "confirm" a diagnosis of "constipation," as this is not specific and may also be found during surgical emergencies (e.g. appendicitis).

Management

• Based on diagnosis

Disposition

• Depends on underlying etiology
  • If symptoms are fully resolved and the patient has a benign abdominal exam, most patients go home with return precautions
  • In general, unclear cases with continued pain should NOT be discharged home

See Also

• Abdominal Pain
• Pyloric Stenosis
• Meckel's Diverticulum
• Inguinal Hernia (Peds)