Acute Abdominal Pain in Children

 


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Am Fam Physician. 2016 May 15;93(10):830-837.

Author disclosure: No relevant financial affiliations.

Acute abdominal pain accounts for approximately 9% of childhood primary care office visits. Symptoms and signs that increase the likelihood of a surgical cause for pain include fever, bilious vomiting, bloody diarrhea, absent bowel sounds, voluntary guarding, rigidity, and rebound tenderness. The age of the child can help focus the differential diagnosis. In infants and toddlers, clinicians should consider congenital anomalies and other causes, including malrotation, hernias, Meckel diverticulum, or intussusception. In school-aged children, constipation and infectious causes of pain, such as gastroenteritis, colitis, respiratory infections, and urinary tract infections, are more common. In female adolescents, clinicians should consider pelvic inflammatory disease, pregnancy, ruptured ovarian cysts, or ovarian torsion. Initial laboratory tests include complete blood count, erythrocyte sedimentation rate or C-reactive protein, urinalysis, and a pregnancy test. Abdominal radiography can be used to diagnose constipation or obstruction. Ultrasonography is the initial choice in children for the diagnosis of cholecystitis, pancreatitis, ovarian cyst, ovarian or testicular torsion, pelvic inflammatory disease, pregnancy-related pathology, and appendicitis. Appendicitis is the most common cause of acute abdominal pain requiring surgery, with a peak incidence during adolescence. When the appendix is not clearly visible on ultrasonography, computed tomography or magnetic resonance imaging can be used to confirm the diagnosis.

Acute abdominal pain accounts for approximately 9% of childhood visits to primary care.1 The initial assessment of acute abdominal pain should focus on the severity of illness and whether there is a potential surgical cause of abdominal pain. For this article, surgical cause refers to a condition that may require surgical intervention. In children presenting to the emergency department with acute abdominal pain, the incidence of appendicitis or other causes needing surgical intervention ranges from 10% to 30%25; however, in general, the incidence of surgical acute abdominal pain is 2%.1

View/Print Table

BEST PRACTICES IN EMERGENCY MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Computed tomography is not necessary in the routine evaluation of abdominal pain.

American Academy of Pediatrics

Do not do computed tomography for the evaluation of suspected appendicitis in children until after ultrasonography has been considered as an option.

American College of Surgeons


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

BEST PRACTICES IN EMERGENCY MEDICINE: RECOMMENDATIONS FROM THE CHOOSING WISELY CAMPAIGN

RecommendationSponsoring organization

Computed tomography is not necessary in the routine evaluation of abdominal pain.

American Academy of Pediatrics

Do not do computed tomography for the evaluation of suspected appendicitis in children until after ultrasonography has been considered as an option.

American College of Surgeons


Source: For more information on the Choosing Wisely Campaign, see http://www.choosingwisely.org. For supporting citations and to search Choosing Wisely recommendations relevant to primary care, see http://www.aafp.org/afp/recommendations/search.htm.

View/Print Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Urinalysis, complete blood count, pregnancy test, and erythrocyte sedimentation rate or C-reactive protein should be the initial laboratory tests in the evaluation of acute abdominal pain in children.

C

1518

Ultrasonography is the imaging choice for acute abdominal pain in children.

C

2328

Opiates may be safely used in children with acute abdominal pain without delaying or affecting the accuracy of diagnosis.

A

3436


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Urinalysis, complete blood count, pregnancy test, and erythrocyte sedimentation rate or C-reactive protein should be the initial laboratory tests in the evaluation of acute abdominal pain in children.

C

1518

Ultrasonography is the imaging choice for acute abdominal pain in children.

C

2328

Opiates may be safely used in children with acute abdominal pain without delaying or affecting the accuracy of diagnosis.

A

3436


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case

The Authors

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CARIN E. REUST, MD, MSPH, is an associate professor in clinical family and community medicine at the University of Missouri–Columbia....

AMY WILLIAMS, MD, MSPH is an assistant professor in clinical family and community medicine at the University of Missouri–Columbia.

Address correspondence to Carin E. Reust, MD, MSPH, University of Missouri–Columbia, MA 303 HSC, Columbia, MO 65212 (e-mail: reustc@health.missouri.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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