Acute abdominal pain is a common symptom in the pediatric population. As with adults, surgical causes must be excluded, but in children there is greater urgency due to lower physiological reserves. Being aware of the differential diagnoses of acute abdominal pain in children, both surgical and medical, is important knowledge for students, in addition to details about the assessment and management of key conditions.

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Differential Diagnosis of Pediatric Acute Abdominal Pain

There is a wide variety of conditions that can cause acute abdominal pain in a child, including surgical causes, medical causes and non-specific abdominal pain.

Causes of abdominal pain

Details

Surgical causes

Acute appendicitis

Classically begins as peri-umbilical pain that then migrates to the right iliac fossa.

Intussusception

Most common between 3 and 18 months of age. Intermittent attacks of abdominal pain with screaming, pallor and drawing up of legs.

Volvulus

Occurs secondary to malrotation in an infant who classically presents with bilious vomiting due to small bowel obstruction.

Strangulated inguinal hernia

Tender groin lump present.

Peritonitis

Generalised tenderness with signs of peritonism, including guarding and rigidity. Patient may lie still to avoid provocation of pain.

Pancreatitis

Epigastric or left upper quadrant pain that radiates to the back.

Testicular torsion

Tender, swollen testes.

Trauma

History or signs of trauma present.

Medical causes

Gastroenteritis

Triad of fever, diarrhea and abdominal pain.

Hepatitis

Pain in the right upper quadrant.

Inflammatory bowel disease

May be associated with episodes over a long time period

Constipation

Lower lobe pneumonia

Referred pain to upper abdomen accompanied by respiratory symptoms.

Urinary tract infection

Presence of urinary symptoms such as dysuria.

Diabetic ketoacidosis

Associated with hyperglycaemic symptoms of polyuria, polydipsia and polyphagia, and dehydration.

Other causes of pediatric acute abdominal pain include gynecological causes in girls such as ovarian cyst torsion or rupture, Mittelschmerz (mid-cycle pain), pelvic inflammatory disease and ectopic pregnancy. Rare causes of abdominal pain include Henoch-Schonlein purpura and sickle cell crisis.

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