Sudden abdominal events in children

  'Sudden abdominal events (NPB)'  are a disease of the abdomen that emerge   unexpectedly and sharply , affect the patient mostly in full health, and the minority deteriorates the steady state of the abdomen before. '' definition according to Arnold Jirásk)

In contrast to NPB of adults, NPB often occurs in children, especially in newborn and infant age, on the basis of congenital defects.

Distribution of NPB in children

 * congenital (arising on the basis of congenital defects)
 * gained
 * accidental
 * non-injurious
 * inflammatory
 * ileous
 * perforation
 * bleeding

The most common NPB in children

 * history of trauma: contusion, bleeding into the GIT and abdominal cavity, organ rupture, pancreatic injury
 * no previous injury':
 * 0-2 years: intussusception, inguinal hernia, megacolon congenitum, GIT stenoses and atresia
 * 2-5 years: uropathy, intussusception, purpura, tumor
 * over 5 years: acute appendicitis, scrotal syndrome, uropathy, gynecological problems, Meckel's diverticulum, tumor

NPB based on birth defects

 * usually have the character of ileous NPB
 * particularly affect newborn and infant
 * subjective symptoms': abdominal pain (restlessness, refusal of food), vomiting, bowel obstruction (gas retention and stools/mumps)
 * objective symptoms':
 * general – pulse, breathing, temperature, icterus
 * local – look (bloated belly), palpate, listen, tap, per rectum (obstruction of the rectum)
 * other symptoms: polyhydramnios
 * examination: laboratory, USG, X-ray

Examples of VVV causing NPB

 * congenital hypertrophic pyloric stenosis, compression of the pylorus by an aberrant vessel, gastric torsion and volvulus, congenital microgastria, annular pancreas
 * congenital atresias of the alimentary canal
 * congenital biliary atresia, choledochal cyst (Caroli syndrome)
 * intestinal malrotation, omphalocele, Beckwith-Wiedemann syndrome, umbilical cord hernia, laparoschisis (gastroschisis), vesicointestinal fissure, foreskin (Zachary-Morgan syndrome), nonrotation, compression duodenal hyperfixation, congenital volvulus of the midgut, Ladd's syndrome, internal hernias, reverse rotation, positional anomalies of the intestine, arteriomesenteric occlusion
 * hepatodiaphragmatic interposition of the colon (Chilaiditi syndrome)
 * intussusception (intussusception)
 * Meckel's diverticulum, cystic formations of the abdominal cavity
 * torsion of the spleen
 * Hirschsprung's disease
 * congenital diaphragmatic hernias
 * anorectal malformation
 * meconium ileus, meconium peritonitis

Inflammatory NPB

 * acute appendicitis and associated complications (peritonitis, periappendicular infiltrate, abscess) – the most common non-traumatic NPB in children!
 * chronic appendicitis
 * primary peritonitis
 * acute mesenteric lymphadenitis
 * Crohn's disease
 * necrotizing enterocolitis
 * acute cholecystitis and cholelithiasis – exceptional in children
 * biliary peritonitis in an infant
 * acute pancreatitis
 * serous peritonitis
 * neonatal peritonitis

Ileotic NPB

 * ileus (sudden intestinal obstruction) - division into mechanical, neurogenic and vascular (vascular is rare in children)
 * in children, the mechanical one prevails
 * paralytic (neurogenic) can be partially or completely expressed in all NPB, severe trauma and after operations
 * foreign bodies in the alimentary canal – they can obstruct or perforate!
 * intestinal parasites - roundworms

Anamnesis

 * serious symptoms – pain wakes the child up from sleep, the child does not want to eat, the abdomen hurts when shaking, forces to take a relief position, is accompanied by fever, nausea, vomiting
 * repeated episodes of colic - beware! to volvulus, intussusception
 * in teenage girls – also gynecological issues (menses, sexual activity)
 * it is necessary to look for problems with urination (dysuria, polakisuria), oxyuriasis (= enterobiosis)
 * in older children and adult problems – ulcers, cholelithiasis, urolithiasis
 * we find out the mode of defecation
 * psychological and social problems

Clinical picture

 * acceleration of the heart rate not corresponding to the temperature
 * significant pain during palpation at a certain point, signs of obstruction (silence when listening)
 * changes in the child's behavior - noticeable calmness, apathy alternating with pain, signs of peritoneal irritation
 * tactile resistance
 * pain during per rectal examination
 * abnormal admixture in the stool (raspberry jelly on the glove - watch out for intussusception)
 * inguinal hernia, scrotal syndrome in men (orchitis vs. torsion)
 * for girls, examination by a gynecologist
 * for school children, think about dissimulation
 * look for inflammation in the airways (abdominal pain during pleuropneumonia - be careful, even with pneumonia the child can have appendicitis)
 * abdominal pain with rashes – Henoch-Schönlein purpura, varicella

Accidental NPB received

 * with children, it is always necessary to rule out injury with targeted questions!
 * contusion of the abdominal wall, injury to the spleen, liver, pancreas, perforation of the GIT, bleeding into the abdominal cavity, detachment of the pedicle of the mesentery,...

Anamnesis

 * mechanism of injury – fall from a height, what did the child fall on, where did it hit, what object caused the blunt injury...
 * post-injury condition – consciousness, behavior, complaints, pain, vomiting, abnormal admixture in urine or stool, relief position

Clinical picture

 * look for external signs - hematomas on the wall, bruising in the groin or on the scrotum (possible hemoperitoneum), sensitivity in the pelvic area - cave! – pelvic fracture
 * signs of peritoneal irritation - usually with hemoperitoneum, free air or intestinal contents in the cavity
 * palpable resistance – subcapsular hematoma of the liver, bleeding into the retroperitoneum
 * silence when listening – paralytic post-traumatic ileus
 * sometimes in case of injury to the liver, pancreas or spleen, the findings are minimal, so we send a child suspected of having an abdominal injury to surgery for observation (x-ray, ultrasonography, blood count, ALT, AST, …)

Related Articles

 * Examination of the child's gastrointestinal system
 * Types of pain in NPB ▪ Subjective symptoms of sudden abdominal events ▪ Objective symptoms of sudden abdominal events