acute abdomen in paediatric patients

1. Approach to acute abdomen in
paediatric patients
Presented by :
Dr Mubashir
Moderator :
Dr Sachin Katyal

2. Introduction
Acute abdomen refers to sign and symptoms of
abdominal pain and tenderness that often require
emergency surgical therapy
Abdominal pain in children is one of the most
common presentation and it is important to pick up
on cardinal signs - suggesting serious underlying
disease.

3. Approach
Diagnostic challenge is due to limited ability of a child
to give accurate history.
Some cases require rapid diagnosis and treatment to
prevent significant morbidity or mortality.

5. Common causes
New born
• Intestinal obstruction ( volvulus , hirshsprung,
pyloric stenosis )
• Hernia
• Trauma (during birth )
• Peritonitis

9. Less than 2 years of age
• Constipation
• Acute gastroenteritis
• Hernia , volvulus , intussusception
• Toxin ingestion
• Trauma
• Respiratory illness

11. From 2-18 years of age
• Acute gastroenteritis
• Constipation
• Intestinal obstruction
• Testicular torsion
• Pneumonia
• Mesenteric adenitis
• UTI/ Pyelonephritis
• Trauma
• Appendicitis, pancreatitis, cholecystitis
• Henoch-schnolein purpura
• Food poisoning
• Ovarian torsion
• Pregnancy (ectopic )

13. Red flag signs
Medical
• Septic appearance
• Respiratory symptoms
• Nephrotic syndrome
• Significant dehydration
• Purpuric rash
• Jaundice
• Polyuria/polydipsia

14. Surgical
• Billious vomitus
• Peritoneal pain
• H/O recent significant abdominal trauma
• H/O recent abdominal surgery
• Bloody stool or vomitus

15. History
• Onset , frequency , duration and time of day.
• Quality and character: sharp stabbing , dull, diffuse
or localised pain
• Radiation
• Severity
• Alleviating factors
• Aggravating factors
• Associated symptoms : hematemisis, vomiting,
hematochezia , diarrhea, testicular pain, bilious
emeisis , SOB, etc

16. • Bowel movement pattern and stool quality
• Ingestion of foreign body or toxin
• Dietary history
• Past medical history , family history , social and
psychiatric history
• Travel history.

17. Physical examination
Comprehensive physical examination is necessary ,
including rectal examination.
Common DDx. with findings on physical
examination
1) Gastrointestinal causes
a) Constipation : Abdomen tenderness, palpable fecal
mass.

18. b ) Acute appendicitis : avoids movement , rebound
tenderness +, Mc burneys sign +
c) Gastroenteritis: diffuse pain, abdominal distention ,
hyperactive bowel sound.
d) Trauma: sign of bruising and tenderness +

19. 2) Genitourinary
a) UTI : fever , supra pubic and costovertebral angle
tenderness.
b) Primary Dysmenorrhea : lower abdominal
tenderness.
3) Pulmonary
a) Pneumonia and empyema : tachypnea ,
cyanosis, decreased breath sounds, dullness
on percussion.

20. Other DDx with findings on physical
examination
1)Gastro intestinal
a) Intussusception : abdominal tenderness , palpable
abdominal mass
b) Meckel’s diverticulum: abdominal tenderness with
guarding , rebound tenderness
c) Mesenteric adenitis : diffuse abdominal tenderness
d) Hirschsprung’s disease: abdominal distention,
palpable fecal mass.
e) Volvulus : diffuse abdominal tenderness, guarding
and rigid abdomen.

21. f) Necrotising enterocolitis : abdominal distention,
tenderness, abdominal wall erythema
g) Acute pancreatitis : epigastric tenderness,
tachycardia , abdmonial distention , cullen sign , grey
turner sign
2) Genitourinary
a) Nephrolithiasis : costovertebral angle and flank
tenderness
b) Testicular torsion : tender, edematous testicle ,
absent cremasteric reflex
c) Ovarian torsion : tender pelvic mass.
d) Pregnancy : abdominal tenderness ,

23. Laboratory investigations
CBC
KFT
Urinalysis and urine culture
LFT
Urine pregnancy test and /or serum beta –hCG.
ESR & CRP
Stool microscopy and culture

24. Imaging & other studies
• Plain abdominal X-ray
• Chest X-ray
• Ultrasound scan
• Color doppler
• FAST
• CT scan
• MRI
• Endoscopy or colonoscopy

25. Thank you