Causes of acute abdominal pain in children and adolescents
- Mark I Neuman, MD, MPH
Mark I Neuman, MD, MPH
- Associate Professor of Pediatrics and Emergency Medicine
- 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 — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
The most frequently encountered causes of acute abdominal pain in children presenting for emergency or primary care evaluation will be discussed in this review. The emergency evaluation of children with acute abdominal pain and the evaluation and management of children with chronic abdominal pain are discussed separately. (See "Emergency 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.To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
- D'Agostino J. Common abdominal emergencies in children. Emerg Med Clin North Am 2002; 20:139.
- Festen C. Postoperative small bowel obstruction in infants and children. Ann Surg 1982; 196:580.
- Grant HW, Parker MC, Wilson MS, et al. Adhesions after abdominal surgery in children. J Pediatr Surg 2008; 43:152.
- Sherman P, Czinn S, Drumm B, et al. Helicobacter pylori infection in children and adolescents: Working Group Report of the First World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition. J Pediatr Gastroenterol Nutr 2002; 35 Suppl 2:S128.
- Tam YH, Lee KH, To KF, et al. Helicobacter pylori-positive versus Helicobacter pylori-negative idiopathic peptic ulcers in children with their long-term outcomes. J Pediatr Gastroenterol Nutr 2009; 48:299.
- Oderda G, Mura S, Valori A, Brustia R. Idiopathic peptic ulcers in children. J Pediatr Gastroenterol Nutr 2009; 48:268.
- Loening-Baucke V, Swidsinski A. Constipation as cause of acute abdominal pain in children. J Pediatr 2007; 151:666.
- Carty HM. Paediatric emergencies: non-traumatic abdominal emergencies. Eur Radiol 2002; 12:2835.
- Chang SL, Shortliffe LD. Pediatric urinary tract infections. Pediatr Clin North Am 2006; 53:379.
- Attia M, Zaoutis T, Eppes S, et al. Multivariate predictive models for group A beta-hemolytic streptococcal pharyngitis in children. Acad Emerg Med 1999; 6:8.
- Kanegaye JT, Harley JR. Pneumonia in unexpected locations: an occult cause of pediatric abdominal pain. J Emerg Med 1995; 13:773.
- Reynolds SL, Jaffe DM. Diagnosing abdominal pain in a pediatric emergency department. Pediatr Emerg Care 1992; 8:126.
- Scholer SJ, Pituch K, Orr DP, Dittus RS. Clinical outcomes of children with acute abdominal pain. Pediatrics 1996; 98:680.
- Vignault F, Filiatrault D, Brandt ML, et al. Acute appendicitis in children: evaluation with US. Radiology 1990; 176:501.
- Simanovsky N, Hiller N. Importance of sonographic detection of enlarged abdominal lymph nodes in children. J Ultrasound Med 2007; 26:581.
- Benifla M, Weizman Z. Acute pancreatitis in childhood: analysis of literature data. J Clin Gastroenterol 2003; 37:169.
- Chen CF, Kong MS, Lai MW, Wang CJ. Acute pancreatitis in children: 10-year experience in a medical center. Acta Paediatr Taiwan 2006; 47:192.
- Sai Prasad TR, Chui CH, Singaporewalla FR, et al. Meckel's diverticular complications in children: is laparoscopy the order of the day? Pediatr Surg Int 2007; 23:141.
- Brown CV, Virgilio GR, Vazquez WD. Wandering spleen and its complications in children: a case series and review of the literature. J Pediatr Surg 2003; 38:1676.
- Guglietta PM, Moran CJ, Ryan DP, et al. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 3-2016. A 9-Year-Old Girl with Intermittent Abdominal Pain. N Engl J Med 2016; 374:373.
- Milliner DS, Murphy ME. Urolithiasis in pediatric patients. Mayo Clin Proc 1993; 68:241.
- Gillespie RS, Stapleton FB. Nephrolithiasis in children. Pediatr Rev 2004; 25:131.
- NEUROLOGIC BASIS OF ABDOMINAL PAIN
- LIFE-THREATENING CAUSES
- Malrotation with midgut volvulus
- Incarcerated inguinal or umbilical 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