Acute abdominal surgical presentations in children
Surgical conditions affecting the abdomen in children can be associated with significant morbidity and mortality if they are not recognised and managed appropriately. It is therefore important that the correct diagnosis is made quickly, and the appropriate intervention is initiated in a timely manner and, if necessary, rapid transfer is made to a specialist paediatric surgical facility. This article provides an overview of the different surgical presentations encountered in children, and outlines the most important points in the history, examination and management of such cases, whether encountered in the emergency setting or in the community. Two illustrative case studies have been included to demonstrate how these emergencies may present in clinical practice.
Surgical abdominal emergencies are relatively uncommon in the paediatric population, but may be associated with significant morbidity and mortality if they are not recognised and managed appropriately. Diagnoses of paediatric surgical conditions may be challenging because of their non-specific presentations, particularly in the early stages; many pathologies occur only at specific ages, and are seldom or never seen in adult patients. Table 1 highlights some differences in surgical presentations between children and adults.
Nurses are often the first to encounter unwell children during triage and initial assessment, and therefore play a pivotal role in the early recognition and escalation of unwell patients. The aim of this article is to provide an idea of how surgical abdominal conditions in children present. Two illustrative case studies are included to demonstrate how these emergencies may present in clinical practice and that a structured approach is required in managing such cases.
A study conducted in Taiwan over 3 years, identified that 10% of 3980 paediatric patients who presented to the emergency department (ED) with abdominal pain had a true ‘acute abdomen’ (Tseng et al, 2008). This is defined as a sudden onset of severe abdominal pain with associated nausea or vomiting developing over a short period that needs urgent attention and treatment. It may be caused by an infection, inflammation, vascular occlusion or obstruction (Patterson et al, 2021). The study found that the cause of presentation varied depending on the age of the patient, with acute appendicitis being the most common cause in children older than 1 year (68.7% of cases), followed by traumatic injury. The commonest cause in infants was incarcerated inguinal hernia (45.1%), followed by intussusception (41.9%) (Tseng et al, 2008). A national study from the USA, based on an average of 450 000 paediatric admissions a year, highlighted that surgical conditions accounted for 12.7% of all paediatric discharges (Tzong et al, 2012).
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