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Abdominal Pain

  • General Surgery (D Carney, Section Editor)
  • Published:
Current Treatment Options in Pediatrics Aims and scope Submit manuscript

Opinion statement

This review aims to cover common causes of pediatric abdominal pain across different age groups. We briefly describe each disease and then focus on the most recent surgical practices for treating each condition. There are a number of shifts away from standard treatment practices: in certain cases, necrotizing enterocolitis can be treated with primary peritoneal drainage, Hirschsprung’s disease can be treated with a completely trans-anal pull-through, many pediatric surgeries are now being performed laparoscopically and sometimes through single-incision laparoscopy, and uncomplicated appendicitis may be treated with antibiotics alone. There is significant controversy about the best surgical treatments in pediatrics. While there is a push to perform minimally invasive surgeries, there is also resistance to move away from standardized and well-established practices. Larger studies are hard to conduct for such rare conditions, but they may be necessary to show the clear benefit of these new therapies.

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References and Recommended Heading

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  1. Dominguez KM, Moss RL. Necrotizing enterocolitis. Clin Perinatol. 2012;39(2):387–401. doi:10.1016/j.clp.2012.04.011. Review

    Article  PubMed  Google Scholar 

  2. Kastenberg ZJ, Sylvester KG. The surgical management of necrotizing enterocolitis. Clin Perinatol. 2013;40(1):135–48. doi:10.1016/j.clp.2012.12.011. Review

    Article  PubMed  Google Scholar 

  3. •• Zani A, Pierro A. Necrotizing enterocolitis: controversies and challenges. F1000Res. 2015; 4. doi: 10.12688/f1000research.6888.1. Review. This paper provides a good review of NEC and the different considerations for each treatment option.

  4. Moss RL, Dimmitt RA, Barnhart DC, Sylvester KG, Brown RL, Powell DM, Islam S, Langer JC, Sato TT, Brandt ML, Lee H, Blakely ML, Lazar EL, Hirschl RB, Kenney BD, Hackam DJ, Zelterman D, Silverman BL. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med. 2006;354(21):2225–34. Erratum in: N Engl J Med. 2006 Aug 24;355(8):856

    Article  CAS  PubMed  Google Scholar 

  5. Rees CM, Eaton S, Kiely EM, Wade AM, McHugh K, Pierro A. Peritoneal drainage or laparotomy for neonatal bowel perforation? A randomized controlled trial. Ann Surg. 2008;248(1):44–51. doi:10.1097/SLA.0b013e318176bf81.

    Article  PubMed  Google Scholar 

  6. •• Wetherill C, Sutcliffe J. Hirschsprung disease and anorectal malformation. Early Hum Dev. 2014;90(12):927–32. doi:10.1016/j.earlhumdev.2014.09.016. Review. This paper provides a description of the different surgical therapies for Hirschsprung's disease and explains the benefits and drawbacks of each

    Article  PubMed  Google Scholar 

  7. Langer JC. Laparoscopic and transanal pull-through for Hirschsprung disease. Semin Pediatr Surg. 2012;21(4):283–90. doi:10.1053/j.sempedsurg.2012.07.002. Review

    Article  PubMed  Google Scholar 

  8. Langer JC. Hirschsprung disease. Curr Opin Pediatr. 2013;25(3):368–74. doi:10.1097/MOP.0b013e328360c2a0. Review

    Article  PubMed  Google Scholar 

  9. Sulkowski JP, Cooper JN, Congeni A, Pearson EG, Nwomeh BC, Doolin EJ, Blakely ML, Minneci PC, Deans KJ. Single-stage versus multi-stage pull-through for Hirschsprung’s disease: practice trends and outcomes in infants. J Pediatr Surg. 2014;49(11):1619–25. doi:10.1016/j.jpedsurg.2014.06.002.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Tomuschat C, Zimmer J, Puri P. Laparoscopic-assisted pull-through operation for Hirschsprung’s disease: a systematic review and meta-analysis. Pediatr Surg Int. 2016;32(8):751–7. doi:10.1007/s00383-016-3910-5.

    Article  CAS  PubMed  Google Scholar 

  11. Thomson D, Allin B, Long AM, Bradnock T, Walker G, Knight M. Laparoscopic assistance for primary transanal pull-through in Hirschsprung’s disease: a systematic review and meta-analysis. BMJ Open. 2015;5(3):e006063. doi:10.1136/bmjopen-2014-006063. Review

    Article  PubMed  PubMed Central  Google Scholar 

  12. Langer JC. Intestinal rotation abnormalities and midgut volvulus. Surg Clin North Am. 2017;97(1):147–59. doi:10.1016/j.suc.2016.08.011. Review

    Article  PubMed  Google Scholar 

  13. • Lodwick DL, Minneci PC, Deans KJ. Current surgical management of intestinal rotational abnormalities. Curr Opin Pediatr. 2015;27(3):383–8. doi:10.1097/MOP.0000000000000215. Review. This paper describes different presentations of malrotation and how to approach each one when considering treatment options

    Article  PubMed  Google Scholar 

  14. Catania VD, Lauriti G, Pierro A, Zani A. Open versus laparoscopic approach for intestinal malrotation in infants and children: a systematic review and meta-analysis. Pediatr Surg Int. 2016;32(12):1157–64.

    Article  PubMed  Google Scholar 

  15. Huntington JT, Lopez JJ, Mahida JB, Ambeba EJ, Asti L, Deans KJ, Minneci PC. Comparing laparoscopic versus open Ladd’s procedure in pediatric patients. J Pediatr Surg. 2016; doi:10.1016/j.jpedsurg.2016.10.046.

    PubMed  Google Scholar 

  16. Peters B, Oomen MW, Bakx R, Benninga MA. Advances in infantile hypertrophic pyloric stenosis. Expert Rev Gastroenterol Hepatol. 2014;8(5):533–41. doi:10.1586/17474124.2014.903799. Review

    Article  CAS  PubMed  Google Scholar 

  17. Kamata M, Cartabuke RS, Tobias JD. Perioperative care of infants with pyloric stenosis. Paediatr Anaesth. 2015;25(12):1193–206. doi:10.1111/pan.12792. Review

    Article  PubMed  Google Scholar 

  18. • Hall NJ, Eaton S, Seims A, Leys CM, Densmore JC, Calkins CM, Ostlie DJ, St Peter SD, Azizkhan RG, von Allmen D, Langer JC, Lapidus-Krol E, Bouchard S, Piché N, Bruch S, Drongowski R, MacKinlay GA, Clark C, Pierro A. Risk of incomplete pyloromyotomy and mucosal perforation in open and laparoscopic pyloromyotomy. J Pediatr Surg. 2014;49(7):1083–6. doi:10.1016/j.jpedsurg.2013.10.014. This is a very large retrospective review of laparoscopic and open pyloromyotomies, and this paper discusses the complications with each

    Article  PubMed  Google Scholar 

  19. Siddiqui S, Heidel RE, Angel CA, Kennedy Jr AP. Pyloromyotomy: randomized control trial of laparoscopic vs open technique. J Pediatr Surg. 2012;47(1):93–8. doi:10.1016/j.jpedsurg.2011.10.026.

    Article  PubMed  Google Scholar 

  20. Oomen MW, Hoekstra LT, Bakx R, Ubbink DT, Heij HA. Open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a systematic review and meta-analysis focusing on major complications. Surg Endosc. 2012;26(8):2104–10. doi:10.1007/s00464-012-2174-y. Review

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Charles T, Penninga L, Reurings JC, Berry MC. Intussusception in children: a clinical review. Acta Chir Belg. 2015;115(5):327–33. Review

    Article  CAS  PubMed  Google Scholar 

  22. Marsicovetere P, Ivatury SJ, White B, Holubar SD. Intestinal intussusception: etiology, diagnosis, and treatment. Clin Colon Rectal Surg. 2017;30(1):30–9. doi:10.1055/s-0036-1593429. Review

    Article  PubMed  Google Scholar 

  23. Apelt N, Featherstone N, Giuliani S. Laparoscopic treatment of intussusception in children: a systematic review. J Pediatr Surg. 2013;48(8):1789–93. doi:10.1016/j.jpedsurg.2013.05.024. Review

    Article  PubMed  Google Scholar 

  24. Gray MP, Li SH, Hoffmann RG, Gorelick MH. Recurrence rates after intussusception enema reduction: a meta-analysis. Pediatrics. 2014;134(1):110–9. doi:10.1542/peds.2013-3102. Review

    Article  PubMed  Google Scholar 

  25. Sklar CM, Chan E, Nasr A. Laparoscopic versus open reduction of intussusception in children: a retrospective review and meta-analysis. J Laparoendosc Adv Surg Tech A. 2014;24(7):518–22. doi:10.1089/lap.2013.0415. Review

    Article  PubMed  Google Scholar 

  26. Morris G, Kennedy Jr A, Cochran W. Small bowel congenital anomalies: a review and update. Curr Gastroenterol Rep. 2016;18(4):16. doi:10.1007/s11894-016-0490-4. Review

    Article  PubMed  Google Scholar 

  27. Caracappa D, Gullà N, Lombardo F, Burini G, Castellani E, Boselli C, Gemini A, Burattini MF, Covarelli P, Noya G. Incidental finding of carcinoid tumor on Meckel’s diverticulum: case report and literature review, should prophylactic resection be recommended? World J Surg Oncol. 2014 May 8;12:144. doi:10.1186/1477-7819-12-144. Review

  28. Chan KW, Lee KH, Wong HY, Tsui SY, Wong YS, Pang KY, Mou JW, Tam YH. Laparoscopic excision of Meckel’s diverticulum in children: what is the current evidence? World J Gastroenterol. 2014;20(41):15158–62. doi:10.3748/wjg.v20.i41.15158.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Gezer HÖ, Temiz A, İnce E, Ezer SS, Hasbay B, Hiçsönmez A. Meckel diverticulum in children: evaluation of macroscopic appearance for guidance in subsequent surgery. J Pediatr Surg. 2016;51(7):1177–80. doi:10.1016/j.jpedsurg.2015.08.066.

    Article  PubMed  Google Scholar 

  30. Zani A, Eaton S, Rees CM, Pierro A. Incidentally detected Meckel diverticulum: to resect or not to resect? Ann Surg. 2008;247(2):276–81. doi:10.1097/SLA.0b013e31815aaaf8. Review

    Article  PubMed  Google Scholar 

  31. Soltero MJ, Bill AH. The natural history of Meckel’s diverticulum and its relation to incidental removal. A study of 202 cases of diseased Meckel’s diverticulum found in King County, Washington, over a fifteen year period. Am J Surg. 1976;132(2):168–73.

    Article  CAS  PubMed  Google Scholar 

  32. Pepper VK, Stanfill AB, Pearl RH. Diagnosis and management of pediatric appendicitis, intussusception, and Meckel diverticulum. Surg Clin North Am 2012; 92(3):505–526, vii. doi: 10.1016/j.suc.2012.03.011. Review.

  33. •• Rentea RM, St Peter SD. Pediatric appendicitis. Surg Clin North Am. 2017;97(1):93–112. doi:10.1016/j.suc.2016.08.009. Review. This paper provides a review of the current literature and discusses a number of studies that compare operative and non-operative treatments of appendicitis

    Article  PubMed  Google Scholar 

  34. Armstrong J, Merritt N, Jones S, Scott L, Bütter A. Non-operative management of early, acute appendicitis in children: is it safe and effective? J Pediatr Surg. 2014;49(5):782–5. doi:10.1016/j.jpedsurg.2014.02.071.

    Article  PubMed  Google Scholar 

  35. Gorter RR, van der Lee JH, Cense HA, Kneepkens CM, Wijnen MH, In 't Hof KH, Offringa M, Heij HA; APAC Study Group. Initial antibiotic treatment for acute simple appendicitis in children is safe: short-term results from a multicenter, prospective cohort study. Surgery 2015; 157(5):916–923. doi: 10.1016/j.surg.2015.01.008.

  36. Hartwich J, Luks FI, Watson-Smith D, Kurkchubasche AG, Muratore CS, Wills HE, Tracy Jr TF. Nonoperative treatment of acute appendicitis in children: a feasibility study. J Pediatr Surg. 2016;51(1):111–6. doi:10.1016/j.jpedsurg.2015.10.024.

    Article  PubMed  Google Scholar 

  37. Koike Y, Uchida K, Matsushita K, Otake K, Nakazawa M, Inoue M, Kusunoki M, Tsukamoto Y. Intraluminal appendiceal fluid is a predictive factor for recurrent appendicitis after initial successful non-operative management of uncomplicated appendicitis in pediatric patients. J Pediatr Surg. 2014;49(7):1116–21. doi:10.1016/j.jpedsurg.2014.01.003.

    Article  PubMed  Google Scholar 

  38. Minneci PC, Mahida JB, Lodwick DL, Sulkowski JP, Nacion KM, Cooper JN, Ambeba EJ, Moss RL, Deans KJ. Effectiveness of patient choice in nonoperative vs surgical management of pediatric uncomplicated acute appendicitis. JAMA Surg. 2016;151(5):408–15. doi:10.1001/jamasurg.2015.4534.

    Article  PubMed  Google Scholar 

  39. Tanaka Y, Uchida H, Kawashima H, Fujiogi M, Takazawa S, Deie K, Amano H. Long-term outcomes of operative versus nonoperative treatment for uncomplicated appendicitis. J Pediatr Surg. 2015;50(11):1893–7. doi:10.1016/j.jpedsurg.2015.07.008.

    Article  PubMed  Google Scholar 

  40. Svensson JF, Patkova B, Almström M, Naji H, Hall NJ, Eaton S, Pierro A, Wester T. Nonoperative treatment with antibiotics versus surgery for acute nonperforated appendicitis in children: a pilot randomized controlled trial. Ann Surg. 2015;261(1):67–71. doi:10.1097/SLA.0000000000000835.

    Article  PubMed  Google Scholar 

  41. Steiner Z, Buklan G, Stackievicz R, Gutermacher M, Erez I. A role for conservative antibiotic treatment in early appendicitis in children. J Pediatr Surg. 2015;50(9):1566–8. doi:10.1016/j.jpedsurg.2015.04.008.

    Article  PubMed  Google Scholar 

  42. Brook I. Treating appendicitis with antibiotics. Am J Emerg Med. 2016;34(3):609–10. doi:10.1016/j.ajem.2015.11.063. Review

    Article  PubMed  Google Scholar 

  43. Salminen P, Paajanen H, Rautio T, Nordström P, Aarnio M, Rantanen T, Tuominen R, Hurme S, Virtanen J, Mecklin JP, Sand J, Jartti A, Rinta-Kiikka I, Grönroos JM. Antibiotic therapy vs appendectomy for treatment of uncomplicated acute appendicitis: the APPAC randomized clinical trial. JAMA. 2015;313(23):2340–8. doi:10.1001/jama.2015.6154.

    Article  CAS  PubMed  Google Scholar 

  44. Gonzalez DO, Deans KJ, Minneci PC. Role of non-operative management in pediatric appendicitis. Semin Pediatr Surg. 2016;25(4):204–7. doi:10.1053/j.sempedsurg.2016.05.002.

    Article  PubMed  Google Scholar 

  45. Rothstein DH, Harmon CM. Gallbladder disease in children. Semin Pediatr Surg. 2016;25(4):225–31. doi:10.1053/j.sempedsurg.2016.05.005.

    Article  PubMed  Google Scholar 

  46. Poffenberger CM, Gausche-Hill M, Ngai S, Myers A, Renslo R. Cholelithiasis and its complications in children and adolescents: update and case discussion. Pediatr Emerg Care 2012; 28(1):68–76; quiz 77–8. doi: 10.1097/PEC.0b013e31823f5b1e. Review.

  47. Santucci NR, Hyman PE, Harmon CM, Schiavo JH, Hussain SZ. Biliary dyskinesia in children: a systematic review. J Pediatr Gastroenterol Nutr. 2017;64(2):186–93. doi:10.1097/MPG.0000000000001357.

    Article  PubMed  Google Scholar 

  48. Kozlov Y, Novozhilov V, Baradieva P, Krasnov P, Kovalkov K, Muensterer OJ. Single-incision pediatric endosurgery in newborns and infants. World J Clin Pediatr. 2015;4(4):55–65. doi:10.5409/wjcp.v4.i4.55. Review

    Article  PubMed  PubMed Central  Google Scholar 

  49. Ahn N, Signor G, Singh TP, Stain S, Whyte C. Robotic single- and multisite cholecystectomy in children. J Laparoendosc Adv Surg Tech A. 2015;25(12):1033–5. doi:10.1089/lap.2015.0106.

    Article  PubMed  Google Scholar 

  50. Sacco Casamassima MG, Gause C, Yang J, Goldstein SD, Swarup A, Abdullah F. Safety of outpatient laparoscopic cholecystectomy in children: analysis of 2050 elective ACS NSQIP-pediatric cases. Pediatr Surg Int. 2016;32(6):541–51. doi:10.1007/s00383-016-3888-z.

    Article  PubMed  Google Scholar 

  51. Gould JL, Poola AS, St Peter SD, Aguayo P. Same day discharge protocol implementation trends in laparoscopic cholecystectomy in pediatric patients. J Pediatr Surg. 2016;51(12):1936–8. doi:10.1016/j.jpedsurg.2016.09.008.

    Article  PubMed  Google Scholar 

  52. Childress KJ, Dietrich JE. Pediatric ovarian torsion. Surg Clin North Am. 2017;97(1):209–21. doi:10.1016/j.suc.2016.08.008. Review

    Article  PubMed  Google Scholar 

  53. Erikci VS, Hoşgör M. Isolated salpingeal torsion in children: a case series and review of the literature. Ulus Travma Acil Cerrahi Derg. 2014;20(1):75–8. doi:10.5505/tjtes.2014.26918. Review

    Article  PubMed  Google Scholar 

  54. Schmitt ER, Ngai SS, Gausche-Hill M, Renslo R. Twist and shout! Pediatric ovarian torsion clinical update and case discussion. Pediatr Emerg Care. 2013;29(4):518–523; quiz 524-6. doi:10.1097/PEC.0b013e31828a7822. Review

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Authors and Affiliations

  1. Division of Pediatric Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    Genia Dubrovsky MD & Steven L. Lee MD

  2. Division of Pediatric Surgery, Department of Surgery, Harbor-UCLA, 1000 W Carson Street, Box 461, Torrance, CA, 90509, USA

    Steven L. Lee MD

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  1. Genia Dubrovsky MD
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Correspondence to Steven L. Lee MD.

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Genia Dubrovsky declares no conflicts of interest.

Steven L. Lee declares no conflicts of interest.

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This article is part of the Topical Collection on General Surgery

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Dubrovsky, G., Lee, S.L. Abdominal Pain. Curr Treat Options Peds 3, 148–156 (2017). https://doi.org/10.1007/s40746-017-0084-x

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