Causes of acute abdominal pain in a child

Causes of "acute abdomen": acute appendicitis: acute mechanical ileus; strangulated hernia; trauma to an abdominal organ (rupture of the spleen, liver, intestine, cyst); adhesions after surgery on the abdominal organs: tumor and inflammatory stenosis; intussusception: obstruction by foreign bodies, including gallstones; diverticulitis; gastric and intestinal ulcer; perforation; acute cholecystitis with peritonitis: torsion of the omentum, cysts, tumors; rupture of the fallopian tube during ectopic pregnancy; vascular pathology (thrombosis of the mesenteric arteries, embolism of the aortic bifurcation or aortic aneurysm).

Signs of an "acute abdomen" that usually do not require surgical intervention occur in acute pancreatitis, acute cholecystitis, acute gastritis, enterocolitis, diverticulitis, irritable bowel, acute hepatitis, acute congestive liver disease, alcoholic hepatitis, hemochromatosis, nephrolithiasis, cystopyelitis, adnexitis, median pain, as well as in mesenteric lymphadenitis, tuberculous, gonococcal, chlamydial peritonitis, and familial Mediterranean fever (periodic disease).

When examining a child with abdominal pain syndrome, attention should be paid to the accompanying symptoms. Fever is a sign of infection or inflammation, tachycardia and hypotension are signs of hypovolemia. If the patient is a pubertal girl in shock, the possibility of ovarian cyst torsion, abortion, or ectopic pregnancy should be taken into account. Hypertension may be a sign of vasculitis or hemolytic uremic syndrome. Kussmaul's respiration is characteristic of diabetic ketoacidosis.

The combination of pain localization with symptoms of peritoneal irritation and some other signs allows one to immediately select a group of diseases for differential diagnosis.

• Diffuse abdominal pain with Shchetkin-Blumberg symptom - diffuse peritonitis. Diffuse pain without Shchetkin-Blumberg symptom - acute ileus.
• Small intestinal ileus (colic, vomiting, sunken abdomen with high ileus, flatulence with low obstruction). It is necessary to examine the gates of possible hernias, to exclude adhesive obstruction.
• Obstruction of the colon. Stool and gas retention, vomiting appears late.
• Pain in the epigastric region with irritation of the peritoneum - local peritonitis with ulcer perforation (stomach like a board), acute pancreatitis (soft muscle protection).
• Pain in the epigastric region without irritation of the peritoneum - acute gastritis, pancreatitis, onset of appendicitis (after a few hours the pain moves down to the right), pleuropneumonia, pericarditis, myocardial infarction, diabetic coma, collagenoses, porphyria, dissecting aortic aneurysm.
• Pain in the umbilical region with irritation of the peritoneum - serous peritonitis.
• Pain in the umbilical region without irritation of the peritoneum - mechanical ileus, umbilical hernia, acute enterocolitis, irritable bowel.
• Pain in the right hypochondrium with irritation of the peritoneum - acute cholecystitis, perforating or penetrating ulcer of the duodenum, acute pancreatitis, acute perihepatitis, acute appendicitis.
• Pain in the right hypochondrium without irritation of the peritoneum - cholelithiasis, liver abscess, acute congestive liver, hepatitis, right-sided pleuropneumonia, renal colic, herpes zoster.
• Pain in the left hypochondrium with irritation of the peritoneum - perforation of a stomach ulcer, pancreatitis, rupture of the esophagus, rupture of the spleen.
• Pain in the left hypochondrium without irritation of the peritoneum - splenic infarction or other types of damage to the spleen and left kidney, pancreatitis, pleurisy, myocardial infarction, strangulated diaphragmatic hernia.
• Pain in the right iliac region with irritation of the peritoneum - acute appendicitis, adnexitis, rupture of the fallopian tube, torsion of the ovarian cyst.
• Pain in the right iliac region without peritoneal irritation - regional enteritis, acute ileitis, median pain, ovarian lesions, Meckel's diverticulitis, pancreatitis, pelvic vein thrombosis, inguinal hernia, coxitis.
• Pain in the left iliac region with irritation of the peritoneum - acute diverticulitis.
• Pain in the left iliac region without irritation of the peritoneum - diverticulosis of the colon, irritable colon.
• Pain in the suprapubic region - acute urinary retention, dissecting aortic aneurysm, acute thrombosis of the iliac vessels.

The most likely causes of abdominal pain in children in the first year of life

• Developmental anomalies.
• Meconium ileus.
• Necrotizing enterocolitis.
• Intussusception.
• Strangulated hernia.
• Gastroenteritis.
• Infantile colic.
• Constipation.
• Urinary tract infection.
• Hirschsprung's disease.

The most likely causes of abdominal pain in children aged 2-5 years

• Gastroenteritis.
• Appendicitis.
• Constipation.
• Urinary tract infection.
• Intussusception.
• Injury.
• Viral infections.
• Henoch-Schönlein purpura.
• Mesoadenites.

The most likely causes of abdominal pain in children aged 6-11 years

• Gastroenteritis.
• Appendicitis.
• Constipation.
• Functional pain.
• Urinary tract infection.
• Injury.
• Viral infections.
• Henoch-Schönlein purpura.
• Mesoadenites.

The most likely causes of abdominal pain in adolescents aged 12-18 years

• Appendicitis.
• Gastroenteritis.
• Constipation.
• Cholelithiasis.
• Pancreatitis.
• Dysmenorrhea.
• Median pain.
• Inflammatory diseases of the pelvis.
• Abortion.
• Ectopic pregnancy.
• Testicular/ovarian torsion.
• "Acute scrotum" (orchitis, trauma).

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