Causes of acute abdominal pain in children and adolescents
- Mark I Neuman, MD, MPH
Mark I Neuman, MD, MPH
- Assistant Professor of Pediatrics
- Harvard Medical School
- Section Editors
- Gary R Fleisher, MD
Gary R Fleisher, MD
- Editor-in-Chief — Adult and Pediatric Emergency Medicine
- Section Editor — Pediatric Signs and Symptoms
- Egan Family Foundation Professor
- Harvard Medical School
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The causes of acute abdominal pain in children will be discussed in this review. The emergent evaluation of children with acute abdominal pain and the evaluation and management of children with chronic abdominal pain are discussed separately. (See "Emergent evaluation of the child with acute abdominal pain" and "Chronic abdominal pain in children and adolescents: Approach to the evaluation".)
Abdominal pain is one of the most common complaints in childhood and one that frequently requires urgent evaluation in the office or emergency department. The cause is typically a self-limited minor condition, such as constipation, gastroenteritis, or viral syndrome . The challenge for the clinician is to identify those few patients with abdominal pain who have potentially life-threatening conditions (table 1). The diagnosis is often suggested by the child's age and clinical features (ie, associated symptoms and physical examination findings). (See 'Life-threatening causes' below.)
NEUROLOGIC BASIS OF ABDOMINAL PAIN
Pain receptors in the abdomen include visceral receptors (located on serosal surfaces, within the mesentery, and within the walls of hollow viscera) and mucosal receptors. Visceral receptors respond to mechanical and chemical stimuli whereas mucosal receptors respond primarily to chemical stimuli.
Visceral pain is usually poorly localized. Most visceral digestive tract pain is perceived in the midline because of bilaterally symmetric innervation. In some conditions, such as appendicitis, precise localization of the pain may develop once the overlying parietal peritoneum (which is somatically innervated) becomes inflamed.
Pain originating in the viscera may sometimes be perceived as originating from a site distant from the affected organ. Referred pain usually is located in the cutaneous dermatomes sharing the same spinal cord level as the visceral inputs.
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- NEUROLOGIC BASIS OF ABDOMINAL PAIN
- LIFE-THREATENING CAUSES
- Malrotation with midgut volvulus
- Incarcerated inguinal hernia
- Adhesions with intestinal obstruction
- Necrotizing enterocolitis
- Peptic ulcer disease
- Ectopic pregnancy
- Uncommon life-threatening causes
- COMMON CAUSES
- Gastrointestinal infection
- Other infections
- - Urinary tract infections
- - Streptococcal pharyngitis
- - Pneumonia
- - Viral illnesses
- - Pelvic inflammatory disease
- - Mesenteric lymphadenitis
- Ruptured ovarian cyst
- Foreign body ingestion
- OTHER CAUSES
- INFORMATION FOR PATIENTS