Acute abdominal pain

Acute abdominal pain is a common occurrence. One in a hundred children will experience at least 1 episode of acute abdominal pain that will come to medical attention. However, most episodes are not emergencies. It is the rare episode that requires immediate and accurate action. (3) (Strength of evidence C. Observational study.) Acute appendicitis remains the most common surgical emergency in pediatrics. Although serum markers are helpful, imaging, in particular point of service ultrasonography and targeted computed tomography (CT), has reduced the falsenegative appendectomies to less than 2%. (5) (Strength of evidence C. Observational study.) Improved imaging has changed the course of a child with intussusception. Ultrasonography is close to 100% accurate, resulting in much earlier diagnosis. Incidentally, abdominal CT scanning and magnetic resonance imaging (MRI) have demonstrated that minor small bowel to small bowel intussusceptions occur frequently and are self-resolving. (6) (Strength of evidence D. Expert opinion and review of the literature.) Gallstones and gallbladder sludge are frequent findings on abdominal ultrasonographic images and may not be the cause of abdominal pain. (8) (Strength of evidence C. Observational study.) Cholecystitis has a less specific presentation in children than in adults. Although laboratory tests are helpful, ultrasonography is better than 90% accurate; imaging should be performed in any child with a suggestive history or physical examination findings. (9) (Strength of evidence B. Prospective diagnostic study.) Delayed gallbladder ejection demonstrated by HIDA scan may be an uncommon cause of acute abdominal pain in children. However, many children who undergo cholecystectomy for this reason have recurrence of their pain. (10) (Strength of evidence D. Expert opinion and review of the literature.) Pancreatitis in children is being diagnosed more frequently than in the past. In most children, the pancreatitis will not become chronic. (11) (Strength of evidence C. Observational study.) Ultrasonography is the imaging modality of choice for yielding information about the pancreas and surrounding tissues. However, CT and MRI are superior to ultrasonography for assessing complications of pancreatitis (14) (Strength of evidence C. Observational study.) Malrotation almost always occurs in neonates or infants, but it can occur at any age. Half the cases of malrotation require resection, and in those resected, complications, mainly short bowel syndrome, are common. (16) (Strength of evidence C. Observational study.) Constipation is the most frequently identified cause of acute abdominal pain in children. Estimates of the overall frequency of constipation in childhood are as high as 29%. Diagnosis is suggested by history and physical examination findings. (3) (Strength of evidence C. Observational study.).