Etiology of non-traumatic acute abdomen in pediatric emergency departments

Abstract

Acute abdominal pain is a common complaint in pediatric emergency departments. A complete evaluation is the key factor approaching the disease and should include the patient's age, any trauma history, the onset and chronicity of the pain, the related symptoms and a detailed physical examination. The aim of this review article is to provide some information for physicians in pediatric emergency departments, with the age factors and several causes of non-traumatic acute abdominal pain. The leading causes of acute abdominal pain are divided into four age groups: infants younger than 2 years old, children 2 to 5, children 5 to 12, and children older than 12 years old. We review the information about acute appendicitis, intussusception, Henoch-Schönlein purpura, infection, Meckel's diverticulum and mesenteric adenitis. In conclusion, the etiologies of acute abdomen in children admitted to the emergency department vary depending on age. A complete history and detailed physical examination, as well as abdominal imaging examinations, could provide useful information for physicians in the emergency department to narrow the differential diagnosis of abdominal emergencies and give a timely treatment.

Keywords: Abdominal pain; Non-traumatic acute abdominal pain.

Figure 1

A nodular calcified appendicolith (arrow) in the right lower abdominal quadrant.

Figure 2

Acute appendicitis. A: A blind-ending, non-compressible tubular structure (arrows); an echogenic appendicolith with an acoustic shadow over tip (arrowheads); B: An enlargement of whole diameter of the appendix (arrows) with enhancement and thickening of the appendiceal wall associated with intraluminal fluid collections.

Figure 3

‘‘Pseudokidney’’ sign (A) and ‘‘target sign (arrow)” (B) on ultrasonography.

Figure 4

A concentric ring of the ileum (arrows) from ileo-colic intussusception.

Figure 5

Henoch-Schonlein purpura. A: Sagittal ultrasound image shows more moderate wall thickening of small bowel with ascites; B: Coronal computed tomography shows long segments of thickened, enhancing, fluid filled small bowel (arrows).

Figure 6

Bacterial enteritis. A: Ultrasound showing marked wall thickening of the cecum (arrow) in a child with right lower quadrant pain, which returned to normal; B: 4 d later. Stool cultures were positive for enterohemorrhagic Escherichia coli.

Figure 7

Meckel’s diverticulum. A: Small-bowel obstruction shown on computed tomography (CT) in an 18-year-old boy with pathologically proven Meckel’s diverticulum; B: CT image in an 11-year-old girl shows intussusception (arrows) as a bowel loop containing alternating rings of attenuation. Note dilated proximal small bowel (D) and collapsed terminal ileum (arrowheads).

Figure 8

Mesenteric adenitis. A: Ultrasound shows multiple enlarged lymph nodes (arrowheads) at the base of mesentery, anterior to the inferior vena cava; B: Computed tomography of the abdomen showing clustering of mesenteric lymph nodes with largest diameter of about 11.2 mm (black arrow) and thickening of the bowel wall of terminal ileum.