Abdominal Emergencies

Leah Harrington

Introduction

Principles of Management

Common Abdominal Emergencies

Intussusception

Telescoping of the bowel at the ileocecal junction leading to ischemia, subsequent necrosis, and death if undiagnosed and untreated
Triad of intermittent abdominal pain, vomiting, RUQ abdominal mass, plus occult/gross blood per rectum has a positive predictive value of 100%; but only present in 10-20% cases
Age 2 months to 6 years (peak 5-9 mo), male predominance
High index of suspicion to avoid missed diagnosis
May follow an episode of gastroenteritis, with enlarged mesenteric nodes acting as lead points
Older children may present with intussusception especially if lead points are present (e.g., intestinal lymphosarcoma) or in association with Henoch-Schonlein Purpura
Differential diagnosis: constipation, gastroenteritis, UTI, appendicitis
Small bowel intussusception: short segment, no pathological lead point, in otherwise asymptomatic children: conservative observation

Table 26.1 Major Diagnosis for Age

	INFANT	CHILD	ADOLESCENT
Medical	UTI	UTI	UTI
	Constipation	Constipation	Constipation
	Gastroenteritis	Gastroenteritis	Gastroenteritis
	Sepsis	Functional	Functional
	Gastroesophageal reflux	HSP	IBD
	Colic	IBD	Pelvic inflammatory disease
		HUS	Sickle cell crisis
		Pneumonia	Diabetic ketoacidosis
		Strep throat
		Sickle cell crisis
		Diabetic ketoacidosis
		Mesenteric adenitis
Surgical	Malrotation/volvulus	Intussusception	Appendicitis
	Hirschsprung’s disease	Appendicitis	Cholecystitis
	Necrotizing enterocolitis	Testicular torsion	Ectopic pregnancy
	Incarcerated hernia	Pancreatitis	Testicular torsion
	Intussusception
	Pyloric stenosis