Zusammenfassung
Akute Bauchschmerzen im Kindesalter stellen etwa 5% aller ungeplanten Konsultationen dar. Obwohl dieses Leitsymptom häufig ist, benötigen letztlich nur etwa 1% aller Patienten mit akuten Bauchschmerzen eine chirurgische Intervention. Ursachen derselben können intraabdominale, extraabdominale, systemische und gynäkologische Erkrankungen sein. In den meisten Fällen basiert die Diagnose primär auf einer genauen Anamnese und Analyse des Schmerzcharakters und einer sorgfältigen klinischen Untersuchung. Im vorliegenden Beitrag wird dem klinisch tätigen Pädiater ein praktikables und pragmatisches Konzept bezüglich des Managements dieses häufigen Leitsymptoms vermittelt. Eine frühe und effiziente Schmerztherapie ist auch bei initial unklarer Diagnose sicher und im Interesse des Patienten und Untersuchers.
Abstract
An acute complaint of abdominal pain precipitates approximately 5% of unscheduled pediatric visits. However, in patients presenting with acute abdominal pain the frequency of disease requiring surgical intervention may be as low as 1%. The diverse etiologies include acute surgical emergencies, disorders that will or may require surgical intervention and specific intra-abdominal, extra-intestinal, systemic and gynecological disorders. In most instances a detailed clinical history, careful analysis of the pain character and physical examination are the cornerstones of a timely diagnosis. The aim of this article is to provide a consistent approach with a diagnostic algorithm. Provision of early and efficient analgesia appears to be safe, reasonable and in the best interests of patients, even those with undifferentiated acute abdominal pain.
Literatur
Bundy DG, Byerley JS, Liles EA et al (2007) Does this child have appendicitis? JAMA 298:438–451
Boyle JT (2004) Abdominal pain. In: Walker W, Goulet O, Kleinman RE et al (eds) Pediatric gastrointestinal disease: pathophysiology, diagnosis, management, 4th edn. Decker, Ontario, pp 225–243
Carty HML (2002) Paediatric emergencies: non-traumatic abdominal emergencies. Eur Radiol 12:2835–2828
Doria AS, Moineddin R, Kellenberger CJ et al (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94
Douglas CD, Macpherson NE, Davidson PM, Gani JS (2000) Randomised controlled trial of ultrasonography in diagnosis of acute appendicitis, incorporating the Alvarado score. BMJ 321:919–922
Green R, Bulloch B, Kabani A et al (2005) Early analgesia in children with acute abdominal pain. Pediatrics 105:454–461
Kharbanda AB, Taylor GA, Fishman SJ, Bachur RG (2005) A clinical decision rule to identify children at low risk for appendicitis. Pediatrics 116:709–716
Kim MK, Strait RT, Sato TT, Hennes HM (2002) A randomized clinical trial of analgesia in children with acute abdominal pain. Acad Emerg Med 9(4):281–287
Leung AKC, Sigalet DL (2003) Acute abdominal pain in children. Am Fam Physician 67:2321–2326
Scholer SJ, Pituch K, Orr DP, Dittus RS (1996) Clinical outcomes of children with acute abdominal pain. Pediatrics 98:680–685
Silen W (1991) Cope’s early diagnosis of the acute abdomen, 18th edn. Oxford University Press, New York, pp 57–63
Thomas SH, Silen W (2003) Effect on diagnostic efficacy of analgesia for undifferentiated abdominal pain. Br J Surg 90:5–9
Vermeulen B (2003) Acute appendicitis: influence of early pain relief on the accuracy of clinical and US findings in the decision to operate – a randomised trial. Radiology 210:639–643
Verschelden P, Filiatrault D, Garel L et al (1992) Intussusception in children: reliability of US in diagnosis – a prospective study. Radiology 184:741–744
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Egger, S., Heinz-Erian, P., Fankhauser, M. et al. Akutes Abdomen aus pädiatrischer Sicht. Monatsschr Kinderheilkd 158, 695–704 (2010). https://doi.org/10.1007/s00112-010-2231-3
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DOI: https://doi.org/10.1007/s00112-010-2231-3