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Acute Abdominal Pain In Children: "Classic" Presentations Vs. Reality

December 2000

Abstract

Trying to find surgically correctable problems in children with abdominal pain is like searching for a needle in a stack of…needles. Things are often not what they seem. Children with "classic" gastroenteritis may actually prove to have a perforated appendix, while those with significantly tender abdomens may have pneumonia, streptococcal pharyngitis, or diabetic ketoacidosis. In addition, the established teaching of the pathophysiology of abdominal pain as visceral, somatic, and referred is difficult to reconcile with reality. How does a sore throat or an ear infection cause abdominal pain? Perhaps when some children feel ill, they simply express their malaise as a "belly ache."

Both the history and physical examination may be limiting or misleading. As ED physicians, we can expect to see toddlers who complain of a tummy ache but are developmentally unable convey other information. Other times, we may see children who present with altered mental status and appear septic, but who are later found to have intussusception. And, of course, there are myriad rare causes of abdominal pain, such as the dreaded rupture of a splenic hamartoma.1
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