The Indian Journal of Pediatrics

, Volume 80, Issue 3, pp 226–234 | Cite as

Emergency Management of Acute Abdomen in Children

Symposium on PGIMER Management Protocols in Gastrointestinal Emergencies

Abstract

Acute abdomen can be defined as a medical emergency in which there is sudden and severe pain in abdomen with accompanying signs and symptoms that focus on an abdominal involvement. It accounts for about 8 % of all children attending the emergency department. The goal of emergency management is to identify and treat any life-threatening medical or surgical disease condition and relief from pain. In mild cases often the cause is gastritis or gastroenteritis, colic, constipation, pharyngo-tonsilitis, viral syndromes or acute febrile illnesses. The common surgical causes are malrotation and Volvulus (in early infancy), intussusception, acute appendicitis, and typhoid and ischemic enteritis with perforation. Lower lobe pneumonia, diabetic ketoacidosis and acute porphyria should be considered in patients with moderate-severe pain with little localizing findings in abdomen. The approach to management in ED should include, in order of priority, a rapid cardiopulmonary assessment to ensure hemodynamic stability, focused history and examination, surgical consult and radiologic examination to exclude life threatening surgical conditions, pain relief and specific diagnosis. In a sick patient the initial steps include rapid IV access and normal saline 20 ml/kg (in the presence of shock/hypovolemia), adequate analgesia, nothing per oral/IV fluids, Ryle’s tube aspiration and surgical consultation. An ultrasound abdomen is the first investigation in almost all cases with moderate and severe pain with localizing abdominal findings. In patients with significant abdominal trauma or features of pancreatitis, a Contrast enhanced computerized tomography (CECT) abdomen will be a better initial modality. Continuous monitoring and repeated physical examinations should be done in all cases. Specific management varies according to the specific etiology.

Keywords

Acute abdomen Acute appendicitis Children Infantile colic Intussusception 

Notes

Conflict of Interest

None.

Role of Funding Source

Resources of the department.

References

  1. 1.
    Scholer SJ, Pituch K, Orr DP, Dittus RS. Clinical outcomes of children with acute abdominal pain. Pediatrics. 1996;98:680–5.PubMedGoogle Scholar
  2. 2.
    Choudhary P, Bagga A, Chugh K, Ramji S, Gupta P. Principles of pediatric and neonatal emergencies. 3rd ed. New Delhi: JAYPEE; 2011. pp. 645–54.Google Scholar
  3. 3.
    Ross A, LeLeiko NS. Acute abdominal pain. Pediatr Rev. 2010;31:135–44.PubMedCrossRefGoogle Scholar
  4. 4.
    Leung AK, Sigalet DL. Acute abdominal pain in children. Am Fam Physician. 2003;67:2321–6.PubMedGoogle Scholar
  5. 5.
    Stevenson RJ, Ziegler MM. Abdominal pain unrelated to trauma. Pediatr Rev. 1993;14:302–11.PubMedCrossRefGoogle Scholar
  6. 6.
    Kliegman RM, Jenson HB, Behrman RE, Stanton BF. Nelson textbook of pediatrics. 19th ed. Philadelphia & New Delhi: Elsevier-Saunders; 2011. pp. 1247–8.Google Scholar
  7. 7.
    Aviral, Chana RS, Ahmad I. Role of ultrasonography in the evaluation of children with acute abdomen in the emergency set-up. J Indian Assoc Pediatr Surg. 2005;10:41–3.CrossRefGoogle Scholar
  8. 8.
    Vasavada P. Ultrasound evaluation of acute abdominal emergencies in infants and children. Radiol Clin N Am. 2004;42:445–56.PubMedCrossRefGoogle Scholar
  9. 9.
    Singhi S, Surpure JS. Synopsis of pediatric emergency care. 2nd ed. Delhi: Peepee; 2010. pp. 304-11.Google Scholar
  10. 10.
    Kim MK, Strait RT, Sato TT, Hennes HM. A randomized clinical trial of analgesia in children with acute abdominal pain. Acad Emerg Med. 2002;9:281–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Green R, Bulloch B, Kabani A, Hancock BJ, Tenenbein M. Early analgesia for children with acute abdominal pain. Pediatrics. 2005;116:978–83.PubMedCrossRefGoogle Scholar
  12. 12.
    Bailey B, Bergeron S, Gravel J, Bussieres JF, Bensoussan A. Efficacy and impact of intravenous morphine before surgical consultation in children with right lower quadrant pain suggestive of appendicitis: a randomized controlled trial. Ann Emerg Med. 2007;50:371–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Thomas SH, Silen W, Cheema F, et al. Effects of morphine analgesia on diagnostic accuracy in emergency department patients with abdominal pain: A prospective randomized trial. J Am Coll Surg. 2003;196:18–31.Google Scholar

Copyright information

© Dr. K C Chaudhuri Foundation 2013

Authors and Affiliations

  1. 1.Department of Pediatrics, Advanced Pediatrics CentrePost Graduate Institute of Medical Education and ResearchChandigarhIndia
  2. 2.Department of GastroenterologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia

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