Abdominal pain (peds)

This page is for pediatric patients. For adult patients, see: abdominal pain, abdominal pain in pregnancy, and/or abdominal pain (geriatrics)

Background

• Bilious emesis is a surgical emergency until proven otherwise

Clinical Features

Side-by-side comparison of quadrants and regions.

Chart of commonly reported referred pain sites.

• Abdominal pain
• May be associated with nausea, vomiting, or diarrhea
• Fever may be present in pain from infectious etiology

Differential Diagnosis

Pediatric Abdominal Pain

0–3 Months Old

• Emergent
  • Necrotizing Enterocolitis
  • Volvulus
  • Testicular torsion
  • Inguinal hernia
    • Incarcerated hernia
  • Trauma
  • Pyloric stenosis
  • Toxic megacolon
  • Hirschsprung's Disease
• Nonemergent
  • Constipation
  • Acute Gastroenteritis
  • Colic

3 mo–3 y old

• Emergent
  • Intussusception
  • Testicular Torsion
  • Trauma
  • Volvulus
  • Appendicitis
  • Toxic megacolon
  • Vaso-occlusive crisis
• Nonemergent
  • Acute Gastroenteritis
  • Constipation
  • Urinary tract infection
  • Henoch-Schonlein purpura

3 y old–adolescence

• Emergent
  • Appendicitis
  • DKA
  • Vaso-occlusive crisis
  • Toxic ingestion
  • Testicular Torsion
  • Ovarian Torsion
  • Ectopic Pregnancy
  • Trauma
  • Toxic megacolon
  • Inflammatory bowel disease
  • Gastric ulcer disease
  • Ovarian cyst
  • Pregnancy
  • Pancreatitis
  • Cholecystitis
  • Intussusception (to age 6)
• Nonemergent
  • Constipation
  • Acute Gastroenteritis
  • Nonspecific viral syndrome
  • Streptococcus pharyngitis
  • Urinary tract infection
  • Pneumonia
  • Renal Stone
  • Henoch-Schonlein purpura
  • Inflammatory bowel disease
  • Vulvovaginitis

Evaluation

Depends on location and history

• Consider:
  • hCG
    • Consider ectopic pregnancy in any female of reproductive age
  • Urinalysis
  • CBC
  • Chemistry
• Possible imaging:
  • Ultrasound
    • Appropriate for intussusception, ovarian/testicular torsion, gallbladder, pregnancy, appendicitis
  • CT
    • May be associated with 1/1,000 lifetime risk of malignancy
  • Abdominal radiography
    • Abdominal plain xray films are specific, but not sensitive. As such, they have very little utility in the workup of pediatric abdominal pain, unless concerned for a foreign body. Do NOT use films to "confirm" a diagnosis of "constipation," as this is not specific and may also be found during surgical emergencies (e.g. appendicitis).

Management

• Based on diagnosis

Disposition

• Depends on underlying etiology
  • If symptoms are fully resolved and the patient has a benign abdominal exam, most patients go home with return precautions
  • In general, unclear cases with continued pain should NOT be discharged home

See Also

• Abdominal Pain
• Pyloric Stenosis
• Meckel's Diverticulum
• Inguinal Hernia (Peds)