Pediatric Emergencies: Non-traumatic Abdominal Emergencies

These causes are age related and can broadly be divided into those that occur in the neonatal period, the infant and toddler, and the child aged 3 years to teenager (Table 1). It must be always kept in mind that, inevitably, there is some overlap and common entities can present atypically. The presenting symptoms of an abdominal emergency in childhood are mainly vomiting, abdominal distension, abdominal pain and sometimes fever.A careful clinical history followed by thorough physical examination is extremely important in reaching a provisional diagnosis, although this may be difficult to achieve, particularly in a distressed child. Vomiting may be bilious or non-bilious.Distinction needs to be made between green bile-stained vomitus,which must always be taken seriously, and the sometimes yellowish colour of gastric content which is not necessarily indicative of pathology. Pain localisation in young children is poor, particularly in an irritable and uncooperative child, or in a child too young to communicate. The site of pain is therefore less helpful in making the diagnosis in children than adults. Findings on abdominal physical examination which can be challenging in young children depend on the cause and range from a normal abdomen on palpation to the rigidity of peritonitis, a palpable mass, or a distended abdomen. A provisional working diagnosis is made, based on history, examination and basic blood and urine analysis. A request for imaging will follow if immediate surgery is not indicated. 7.3.