This document discusses common causes of abdominal pain in infants and children. It covers: 1. Symptoms of different conditions affecting the stomach, small intestine, and large intestine like vomiting, abdominal distention, and failure to pass stool. 2. Common mechanical and functional causes of abdominal pain organized by age group, including pyloric stenosis, intestinal atresias, malrotation, and intussusception. 3. Details about two specific conditions - malrotation, which has a risk of volvulus, and intussusception, which can sometimes be treated non-operatively with enemas but often requires surgery for irreducible cases or those with perforation.

1. By: Dr Ismah
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2. • Bile stained vomitus
• Delayed BO >24 hrs after born
• Colicky abdominal pain
- Intermittent crying
• Abdominal distention
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3. Stomach outlet Small intestine Large intestine
• Vomiting severe,
projectile
• Loss of electrolytes
• Dehydrated
• Vomiting less
severe
• Loss of electrolytes
and bile
• Dehydrated
• Very less vomiting
• Abdominal
distention
• Fail to pass stool
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4. Neonates Infants Preschool
(<5 y/o)
School-aged
(>5 y/o)
A. Mechanical
• Pyloric stenosis
• Intestinal atresia,
stenosis
• Malrotation
• Volvulus
• Abdominal wall
defects
• Anorectal
anomalies
• Incarcerated
hernia
• Intussusception
B. Functional
• Necrotizing
enterocolitis
• Hirschsprung’s
disease
• Septicaemia
• Hypothyroidism
• Malrotation
with midgut
volvulus
• Intussusception
(3months to
3years)
• Incarcerated
hernia
• Intussusception
• Incarcerated
hernia
• Perforated
appendicitis
• IBD
• Intrinsic lesions
such as polyps,
masses or
Merkel’s
diverticulum
• Extrinsic
compression
from
incarcerated
hernia,
perforated
appendicitis or
post-operative
adhesions
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5. • Incidence 1:2700 births
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6. 6
Double bubble
sign

7. • 1:500 births (US)
• Intestinal non rotation or incomplete rotation around the
superior mesenteric artery
• Malrotation is often not evident until the baby
experiences a twisting of the intestine known as a
volvulus
• In the hands of experienced ultrasonographers,
ultrasonography has been shown to be very sensitive
(approximately 100%) in detecting neonatal malrotation
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In this upper GI series with
abnormal results, the duodenum
does not cross the midline, and
the small bowel is present only
in the right side of the abdomen
These 2 lower GI series show the
cecum (arrows) in the right upper
quadrant, indicative of malrotation

9. • Telescoping of one portion of intestine to another
• 1:2000 births (US)
• Bloody jelly stool
• Nonoperative reduction with a therapeutic enema/air. Its
contraindications are peritonitis and any evidence of
perforation on plain x ray
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10. 10
Barium enema shows intussusception
in the descending colon

11. • Fluid and electrolyte replacement
• NBM and NG tube decompression
• Early surgical consultation
• Indications for emergeny laparotomy
• Malrotation with or without midgut volvulus
• Pneumoperitoneum
• Irreducible intussusception
• Peritonitis
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