Exploratory laparoscopy for recurrent right lower quadrant pain in a pediatric population

Abstract

Recurrent or chronic abdominal pain can be a challenging problem when conventional diagnostic studies fail to identify the cause. It is estimated that up to one-third of children suffer from abdominal pain, and in this population recurrent pain can be even more challenging. Although recurrent right lower quadrant (RLQ) or periumbilical pain may be attributed to chronic appendicitis, this diagnosis remains controversial. Our aim was to evaluate pediatric patients who had undergone laparoscopic exploration for chronic RLQ abdominal pain to determine their histologic diagnosis, etiology of pain, and contributing factors that may predict a positive outcome. Patients with abdominal pain greater than 1 month in duration who ultimately underwent laparoscopic exploration and appendectomy were included in the study. Patients were excluded if an identified source of pain was discovered during preoperative workup, or if postoperative follow-up was less than 2 years. Intraoperative findings were noted, and all specimens were histologically examined with additional, subsequent independent review. Pertinent findings from preoperative diagnostic tests, mental health history, and pre and postoperative symptomatology were noted. Patient outcomes were recorded at the time of follow-up and after 2 years to assess resolution of their symptoms. Of the 44 patients studied, 31 (70.5%) had partial or complete resolution of symptoms at 2 years. Thirteen (29.5%) continued to have pain. Twenty-eight patients (63.6%) had abnormal histology identified on appendiceal examination, and 14 had other abnormalities found at laparoscopy (31.8%). Eighteen patients were being treated for psychiatric diagnosis, and 21 suffered from chronic headaches. There were no long-term complications from surgery. Long-term follow-up revealed that 70% reported complete or partial relief of their RLQ pain at 2 years. No factors were identified that may be helpful in predicating outcome in this population. While exploration was beneficial for a majority of this population, patients and parents should be warned that this intervention might not provide the relief of symptoms or provide the diagnostic answer to their pain.

Recurrent abdominal pain in young pre-menarchal female: clinical and surgical observations

“…Early laparoscopy is not the treatment of choice in these patients and many surgeons decide to explore when common tests and observation are not able to differentiate medical versus surgical treatment plan [4].…”

Role of diagnostic laparoscopy in chronic and recurrent abdominal pain

“…The advantage of laparoscopy in these patients is that they can be provided therapy in the same setting. Kolts et al,3 in their study of 44 children with chronic lower abdominal pain, showed resolution of symptoms in 70.5% of cases after appendectomy. Similarly, in our series complete or partial relief was obtained in 77.7% of patients.…”

Is elective appendicectomy is a valuable option in children, with chronic undiagnosed right lower abdominal pain? A prospective study

“…Similar views have been echoed in other studies addressing this issue. [6][7][8] Gorenstein series has clearly shown that in a significant number of cases the pain subsides even if the removed appendix is normal on histology. 5 In our series 5 cases had a normal appendix on histology.…”