Pediatric Abdominal Problems
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ώ X-rays and Constipation:
 - "The recommendation to perform a plain abdominal radiograph in case of
 doubt of the presence of constipation in a child cannot be supported by
 this systematic review," the investigators conclude.
 [Arch Pediatr Adolesc Med 2005;159:671-678.]

ώ Acute Abdomens in Kids
  - It is said that of acute abdomens in 5-15 year old girls, 10% is from
    ovarian torsion.

ώ Intussception
 - 3 months - 3 years
 - younger group:  usually ileocolic, from ? hypertrophied
   Peyer's Patches causing a focal weakness
 - in 1 year-3 year old group, though, can be associated with tumors
 - diagnostic features:
  + intermittent crying with "drawing up" of legs
  + lethargic, limp
  + vomiting
  + "currant jelly" (bloody) stool:  late sign
  + +/- blood on rectal exam
  + "dance sign": palpation of not much in the RLQ with a "sausage-like"
    RUQ mass
  + Abdominal X-ray may show
   - obstruction
   - air not throughout colon
   - gas in colon in RLQ may help exclude
   - bowel gas in RLQ may not be colon, may be small bowel loops
   - may see intussception in transverse colon
INTUSSUSCEPTION
Signs & Symptoms
• Intermittent, colicky abdominal pain
• Currant jelly stools are a late finding
• May have RUQ mass
• Emesis ?? bilious
• Heme-positive stools
• ALOC
INTUSSUSCEPTION
Diagnosis
• Abdominal films- may be normal initially, but then may see signs of 
obstruction, paucity of air and dilated loops of bowel
INTUSSUSCEPTION
Air versus Contrast Enema?
• PROS
– Inert
– Rapid
• CONS
– May miss the lead point
– Less radiation
– Air perforation
better than contrast
– Easier to administer
– Poorer visualization
INTUSSUSCEPTION
What is it?
• Prolapse of one part of the intestine into the
lumen of an immediately adjacent distal
part
• Most common location: ileo-colic
• Mesentery and venous supply obstruct=>
mucosal edema and increased pressure+>
arterial flow obstruction
INTUSSUSCEPTION
What causes it?
• Idiopathic in children less than 2 years
• Meckel’s Diverticulum
• HSP
• Polyps
• Tumors Ex-lymphoma
• Post-rotaviral vaccination