Differential Diagnosis of Pediatric Acute Abdominal Pain
There are a variety of conditions that may cause acute abdominal pain in a child. The age of the child determines the differential diagnosis.
Differential diagnosis of acute abdominal pain by predominant age:
|Infants and toddlers||School-aged toddlers||Adolescents|
|Incarcerated hernia||Appendicitis||Pelvic Inflammatory Disease|
|Meckel diverticulum||Respiratory infections||Pregnancy|
|Intussusception||Urinary tract infections||Dysmenorrhea|
|Volvulus||Diabetic ketoacidosis||Ovarian/ testicular torsion|
|Urinary Tract Infection||Trauma||Pancreatitis|
|Hirschsprung’s disease||Henoch-Schönlein purpura||Inflammatory bowel disease|
The causes of abdominal pain in a child are divided into surgical causes, medical causes, and non-specific abdominal pain.
|Causes of abdominal pain||Details|
|Acute appendicitis||Classically begins as peri-umbilical pain that then migrates to the right iliac fossa, seen in school-aged children and adolescents.|
|Intussusception||Most common between 3 and 18 months of age. Intermittent attacks of abdominal pain with screaming, pallor, and drawing 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||Generalized tenderness with signs of peritonism, including guarding and rigidity. The patient may lie still to avoid provocation of pain.|
|Pancreatitis||Epigastric or left upper quadrant pain that radiates to the back.|
|Testicular torsion||Seen in adolescents, Tender, swollen testes.|
|Trauma||Mostly found in school-aged children, history or signs of trauma present.|
|Gastroenteritis||Triad of fever, diarrhea and abdominal pain.|
|Hepatitis||Pain in the right upper quadrant.|
|Inflammatory bowel disease||May be associated with episodic abdominal pain over a long time period.|
|Constipation||Common in infants and school-aged children.|
|Lower lobe pneumonia||Referred pain to the upper abdomen accompanied by respiratory symptoms.|
|Urinary tract infection||Presence of urinary symptoms such as dysuria.|
|Diabetic ketoacidosis||Associated with hyperglycemic 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 that should always be considered, include Henoch-Schonlein purpura and sickle cell crisis.