Abdominal pain in childhood
The differential diagnosis of abdominal pain in childhood contains
the conditions found in adults. However, making the correct diagnosis
more difficult as younger children may have difficulty expressing
and if the child is able to describe the pain they frequently have
in localising it accurately.
Also in children there are a few
are rarely, if ever, described in adults. In many hospitals younger
with abdominal pain are frequently admitted under the paediatricians
than the surgeons.
Classifying the causes into some memorable list through which one can
under the watchful eye of the examiner (or worse, the parents) is
It can be helpful to think of the abdominal structures and the
may affect them. It is sometimes helpful to separate acute and
conditions though, of course, the first attack of a chronic condition
happen at some time.
As with most branches of medicine it is important
the common conditions well but not to forget the important rare ones.
a first abdominal migraine as mesenteric adenitis is unlikely to make
but missing appendicitis in a young child can rapidly lead to
In the older child this can often be diagnosed as easily as in an
in younger children, particularly those below 5 years the diagnosis is
much less clear. In children of all ages the progression of
be extremely rapid, sometimes taking no more than a few hours from the
symptoms to perforation.
This author has recently seen a fifteen year
clear signs described by the GP apparently settle before being
reviewed by the
surgical registrar only to develop signs of peritonitis from his
appendix the next morning. Older children more typically present with
and central abdominal pain progressing to signs of peritonism in the
fossa (tenderness, guarding and rebound). A good differentiating
for peritonism is that movement hurts the child.
They may be pyrexial
may or may not vomit and may or may not have an abnormal blood count.
at the right time the diagnosis is easy unless, of course, the
appendix is abnormally
Younger children usually go off their food too. Those that are old
complain of tummy pain. Most are very miserable. There may be
and sometimes diarrhoea though this is rarely profuse. Abdominal
is usually present but not always clearly focal. Ileus usually
develops as the
Unfortunately there is little else to aid the
A PR is generally distressing for a younger child and generally best
a surgeon if he feels it will help decide whether to take the child to
In more advanced cases an appendix mass may be felt.
In simple terms a high index of suspicion is probably the best way to
missing the this relatively common diagnosis. The diagnosis is
through the combined efforts of paediatrician and surgeon though
This is a condition that usually presents between 3 months and one
age. In this condition the distal ileum folds in on itself and is
into the ascending colon. Why this should happen is not clear, it may
a result of an enlarged lymph node in the intestinal wall being moved
effect of peristalsis.
Sometimes it is associated with a Meckel's
Curiously intussusception can sometimes resolve by itself. On other
treatment is required.