STUDY ON ABDOMINAL PAIN IN CHILDREN

Abstract

Introduction: Acute abdominal pain is one of the most common problems in children admitted to the pediatric casualty and often presents a diagnostic dilemma for primary physicians. Acute abdominal pain in pediatric patients has been a challenge because of the nonspecific nature of symptoms and difficulty in the assessment and physical examination due to the poor ability to express and uncooperative nature of the children. In the present study, we analyzed the etiologies, imaging findings and clinical course of pediatric patients with acute abdominal pain and also analyzed the prevalence of various etiologies of acute abdominal pain in different age groups in children admitted to the pediatric emergency room.

Aim of the study: This study is to analyze the etiology and clinical spectrum in children of different age groups and in different months of a year and role of different imaging modalities in the diagnosis and management of acute abdominal pain in Paediatric emergencies.

Materials and Methods: From January 2017 to December 2018, we retrospectively analysed 2880 case records of pediatric patients who presented to the pediatric emergency room with abdominal pain. Of these patients, 288 were identified as having acute abdomen. These patients were divided into three age groups: less than 2 year, 2 to 5 years and 6 to 12 years. The prevalence, clinical presentations and imaging findings, and hospital courses were analysed. All patients with abdominal pain due to trauma were excluded from this study.

Results: Acute abdomen had a non-traumatic etiology in 245 out of the 288 patients and was due to trauma in 43 patients. There were 157 boys and 131 girls whose age ranged   from 1 month to 12 years (mean age 5.7 years) in non trauma group children. The most common etiology in less than 2 years group was intussusception (23), followed by obstructed inguinal hernia (13). Acute appendicitis was the major cause in children 2 to 5 years (37) followed by mesenteric adenitis (21). Dilated bowel loops and local ileus were the two most common findings demonstrated by plain film X-rays. Children with acute abdominal pain are subjected for abdominal ultrasonogram and CAT scan. Patients with bowel perforation or intestinal obstruction had the longest durations of hospitalization.

Conclusion: The etiology of acute abdomen varied depending on the age of the patient. Acute appendicitis was the most common cause of acute abdomen in children older than 2 year of age, followed by mesenteric adenitis and in less than two years intussusception is the commonest cause. Ultrasonogram was the important screening tool in acute abdomen. Abdominal CT scanning was a useful diagnostic imaging modality in patients with normal sonographic findings but with positive clinical findings.