Acute abdominal pathology in children is a common cause of admission to emergencies.
Interrogation (of the child and his entourage) and a complete clinical examination are essential for the diagnosis, which is quite often difficult because of certain hazards: absence of anamnesis, difficulty of the examination conditions, absence of control an ingestion or inhalation of toxic, trauma … not to mention the possibility of abuse.
The time of the abdominal palpation is essential and delicate. The attitude of the doctor and of the entourage are decisive: it is necessary to reassure, to explain the gestures, while speaking, to monitor the reactions of the child. If it is useful to practice a digital rectal examination, it must sometimes be left for the surgeon to avoid the repetition of this traumatic gesture.
The exam will be complete with, in particular, the search for an extradigestive infectious focus (sometimes responsible for pseudo-appendicular pain by reactive hyperplasia of Peyer’s patches).
– ENT: examination of the eardrums, pharyngeal and oral mucosa (which may suggest an accidental absorption of toxic).
– Pulmonary (infectious focus) and meningeal.
– Exploration of hernia orifices, external genitals (testicles in boys, their torsion is in principle very noisy) and the anal region.
– Skin examination that can guide the diagnosis: purpura (rheumatoid purpura), jaundice (hepatobiliary pathology), cutaneous elements of a porphyria …
The fear of allowing a surgical condition to evolve should not make one hesitate to re-examine the child after a few hours, while ensuring reliable surveillance on the part of those around him.
They are usually unavailable at the child’s home.
The realization of a urine test strip is essential to detect:
– nitrites and leukocytes of a urinary infection;
– but also, sugar and acetone, blood and albumin for other metabolic, renal or urological pathologies.
The other exams dictate that we have made the decision to hospitalize:
– blood work, especially NFS;
– imaging, abdominal ultrasound and CT scan.
The main abdominal emergencies are dependent on age:
Before 3 years:
The causes of acute abdomens are most often medical, however, surgical causes must be ruled out beforehand and it is better to err by excess.
– Acute appendicitis. Rare in this age group, it is not always of typical presentation: an alteration of the general state, a cutaneous pallor, a not frankly depressible abdomen, without a really definite cause, must make think, as well as diarrhea (13% of cases), suggestive if accompanied by tenesmus.
– Acute intussusception is urgently needed. The pains are intermittent, evolving by crises, not calmed by the arms of the mother accompanied by a refusal of food. Beware of misleading forms (pseudoconvulsive, febrile, pseudogastroenteritic).
Any diagnostic doubt must be addressed to the child for the completion of additional examinations, in the first place, an ultrasound.
– The hernial constriction is in principle easy diagnosis by the systematic palpation of the hernia orifices.
After 3 years:
The diagnosis of acute appendicitis is one of the first causes of acute abdomen. Again, many forms are misleading:
– pelvic form with pain in urination, tenesmus, reflex diarrhea;
– mesocoelial form with febrile occlusion chart;
– retrocoelial form with few digestive signs, but lumbar pains;
– subhepatic form with vomiting and pain of the right hypochondrium.
The torsion of the testicle is a surgical emergency, diagnosis generally easy: large acute, painful purse. Twisting of the spermatic cord is seen especially in newborns and adolescents, it is also a surgical emergency: the bursa is painful and enlarged, the testicle is retracted.
In the girl, the torsion of healthy appendix (or on tumor, most often benign), can be seen at any age. The diagnosis is confirmed by ultrasound, the treatment is urgent.
Other surgical causes are rarer: Meckel’s diverticulum, acute cholecystitis, acute pancreatitis, renal colic, urogenital malformations, abdominogenital tumors.