Treating surgical abdominal pain in children
Abdominal pain in children. About one in five children experience abdominal pain at some point. While many cases are caused by gastroenteritis or constipation, some could be due to surgical conditions, such as appendicitis and intussusception, where one part of the intestine slides into another part, folding into itself like a telescope and creating an intestinal obstruction.
Parents should bring their children to a doctor if the tummy (abdominal) pain is constant or severe, localised in the lower right part of the tummy (abdomen). This could be a sign of appendicitis, which is usually accompanied by pain, vomiting, diarrhoea or other symptoms that worsen over 12 to 24 hours. Doctors can usually diagnose the cause by asking questions about the child’s medical history and conducting a physical examination. In some instances, more tests, such as an ultrasound, blood, urine laboratory tests, are done to help with the diagnosis.
Appendicitis is an inflammation of the appendix that could lead to a tear or perforation in the organ, potentially resulting in inflammation throughout the abdomen, blood infection and even death. The treatment for appendicitis is surgery, called an appendicectomy, to remove the appendix.
The operation is usually done through three small puncture wounds in the abdomen, or through an incision in the right lower abdomen, where the appendix is located. The former is called a laparoscopic appendicectomy while the latter is known as an open appendectomy. Both surgeries take about an hour, and the child can usually go home from the hospital after one to two days if the appendix was not perforated, or after five to seven days if there was a perforation.
For abdominal pain that could be due to intussusception, the doctor asks for an ultrasound to locate any intestinal obstructions. Another way to detect intestinal obstructions is through a liquid enema. In this procedure, a fluid called gastrograffin (which has the ability to coat organs so that they can be seen on an X-ray), is put into a tube and inserted through the child’s rectum. A subsequent X-ray of the belly will show if there are any narrowed areas called strictures, intestinal obstructions, or other issues. The gastrograffin passes through the digestive system and does not cause harm.
In some cases, a gastrograffin enema could fix the intussusception itself because of the pressure put on the telescoped intestine when the tube is inserted. Other treatment options include an air enema, or ultrasound guided fluid reduction to reverse the telescoping of the intestine and eliminate the intestinal obstruction. If an enema is not possible because the patient is unstable or the intestine has perforated, surgery is required to resolve the intussusception.
This article has been verified medically by Dr Wong Zeng Hao Joel, paediatric surgeon at Paediatric Surgery & Urology International, Thomson Medical Centre (Singapore).