Medical student

1. ACUTE ABDOMINAL PAIN IN CHILDREN
LT COL SM SHAHADAT HOSSAIN
MCPS,FCPS(surgery)FCPS(Thoracic Surgery)
Adv Trg on Thoracoscopy CNU, South Korea

2. INTRODUCTION
 One-third and one-half of children have non-specific
abdominal pain (NSAP).
 Another one-third have acute appendicitis.
 Remainder, constipation and urinary tract infections.
 A small proportion have more serious pathology.

3. COMMON CAUSES
 Acute appendicitis.
 Intestinal obstruction: Intussusception, inguinal hernia,
adhesions and Meckel’s diverticulum.
 Constipation.
 Urinary tract infection.
 Gastroenteritis.
 Tropical diseases: Ascariasis, typhoid and amoebiasis.

4. ACUTE APPENDICITIS
 Anorexia
 Vomiting
 Central abdominal pain which settles in the right iliac
fossa.
 Early case fever 37.3–38.4°c
 Localised tenderness
 Guarding
 Loose stools or pain on micturition- in pelvic appendicitis

5. INVESTIGATIONS
• CBC-Leukocytosis
• RBS
• Urine-RME
• USG abdomen

6. Ultrasound of abdomen
 Thickened, edematous appendix.
 Non-compressible.
 Per-appendiceal collection.

7. TREATMENT
• Resuscitation with intravenous fluids.
• Analgesia.
• Broad-spectrum antibiotics.
• Appendicectomy: Laparoscopically or through a muscle
splitting right iliac fossa incision.

8. Appendix mass
Treated by non-operative management:
 Intravenous fluids
 Analgesia and
 Broad-spectrum antibiotics
 Daily measurement of the mass
 Record: pulse, temperature-4 hourly
 Interval appendicectomy after 6 weeks.

9. Appendicectomy

10. Laparoscopic appendicectomy

11. MESENTERIC LYMPHADENITIS
It is a self limiting condition due to viral or bacterial
infection.
 Right lower quadrant pain-diffuse in nature
 Fever
 Vomiting

12. CT scan
USG

13. MECKEL’S DIVERTICULUM
 5 cm long.
 Persistent remnant of vitellointestinal duct.
 Present in 2% population.
 Found on the anti-mesenteric side of the ileum, 60 cm
from the ileocaecal valve.
 Congenital diverticulum.
 Contains all three coats of the bowel wall.
 Has own blood supply.

14. Meckel’s diverticulum

15. PRESENTATION
 Asymptomatic: common
 Haemorrhage
 Diverticulitis
 Intussusception
 Chronic ulceration
 Intestinal obstruction
 Perforation

16. TREATMENT
Meckel’s diverticulectomy:
 Broad-based diverticulum; excise the diverticulum.
 If base is indurated, limited small bowel resection of the
involved segment followed by an anastomosis.

17. INTUSSUSCEPTION
 When one portion of the gut invaginates into an
immediately adjacent segment; the proximal into the distal.
 More than 80% are ileocolic.

18. CAUSES
 Peak incidence: 2 months to 2 years.
 Hyperplasia of peyer’s patches; most common.
 Meckel’s diverticulum.
 Enteric duplication cyst.
 Bowel lymphoma.

19. Mechanism of intussusception

20. CLINICAL FEATURES
 Previously healthy infant presents with colicky pain and
vomiting (milk then bile).
 Between episodes, the child appears well.
 Later, pass a ‘redcurrant jelly’ stool.

21. Clinical features
 Dehydration,
 Abdominal distension
 sausage-shaped mass in the right upper quadrant.
 Rectal examination: blood or rarely apex of the
intussusceptum.

22. INVESTIGATION
 Plain radiograph: obstruction, soft-tissue opacity.
 Abdominal ultrasound: confirm the diagnosis.

23. TREATMENT
More than 70% of intussusceptions can be reduced non-
operatively.
1. Intravenous fluids
2. Broad-spectrum antibiotics
3. Nasogastric drainage
4. Non-operative reduction using an air or barium enema.

24. Surgery
Indication:
 Irreducible intussusception.
 Infarction or gangrene.
 Pathological lesion.

25. Operation
 Transverse right upper abdominal incision.
 Reduction is achieved by gently compressing the most
distal part but not to pull, check the viability.
 If non –viable then resection and primary anastomosis.