Pediatric Abdominal Surgical Emergencies

Abstract

Pediatric abdominal surgical emergencies may present the primary physician with a diagnostic challenge. A systematic approach will help to minimize missed diagnoses and resultant complications. It always must be kept in mind that children often have atypical presentations of common entities. Prudent and directed use of laboratory and imaging studies will minimize misdiagnosis. The early involvement of surgical consultants in the care of pediatric patients who have significant abdominal symptoms or findings is always appropriate.

Essential Diagnosis of Abdominal Emergencies in the First Year of Life

“…Rectal bleeding, although thought to be a late sign, is found more frequently than an abdominal mass [1,137]. Losek noted that 75% of cases with intussusception had stool that was guaiac-positive [146].…”

“…As a result, the average time to correctly diagnosis appendicitis is 4 days [171]. As the appendiceal inflammation continues, irritability and lethargy may be noted in the infant or neonate [1,172]. Grunting respirations and parental concerns for their infant's right hip may be noted [6,173].…”

“…A pathologic lead point is a lesion that is thought to cause the intussusception. Common lead points include: appendix, lipoma, intestinal polyp, a Meckel's diverticulum, enlarged Peyer's patch, and HenochSchonlein purpura (HSP)-associated submucosal hematomas [1,132,136]. The second common type, representing 4% of intussusceptions, is ileoileocolic [137].…”

Evaluating the Patient with Right Lower Quadrant Pain

“…Meckel diverticulum is classically referred to by the rule of "2's": affecting 2% of the population, located within 2 feet of the ileocecal valve, approximately 2 inches in length, and often clinically symptomatic before 2 years of age. 32,33 Meckel diverticulum is usually lined by normal ileal mucosa; however, approximately 12% to 19% of Meckel diverticula contain ectopic tissue. [34][35][36] Ectopic tissue is most commonly gastric in origin, but also may be pancreatic, carcinoid, duodenal, or lipomatous in histology.…”

Pathological Case of the Month

“…He was asymptomatic at follow-up 6 months later. T he list of diseases causing intestinal obstruction in neonates and requiring surgical intervention is long and includes incarcerated inguinal hernia, pyloric stenosis, necrotizing enterocolitis, trauma, neoplasm, meconium ileus (eg, cystic fibrosis), meconium blockage syndrome (non-cystic fibrosis), and various other anomalies (intestinal atresia and/or stenosis, malrotation with midgut volvulus, Hirschsprung disease, and duplication cysts) 1 These conditions were among those considered in the clinical differential diagnosis of this infant. Confounders include the limited x-ray film assessment early on and the delayed diagnosis owing to rotavirus infection.…”