Outcome after exploratory laparoscopy for unexplained abdominal pain in childhood.
BACKGROUND
Abdominal pain in childhood is common yet frustrating when unexplained.


OBJECTIVE
To describe the clinical features and outcome of 8 children (6 girls and 2 boys; mean[+/- SD] age, 13 +/- 2 years) with unexplained abdominal pain who underwent exploratory laparoscopy.


METHODS
All 8 patients were examined at an academic pediatric gastroenterology center and referred for exploratory laparoscopy because of unexplained abdominal pain. Laparoscopy was offered after family agreement to pursue behavioral management if the pain and disability did not improve.


RESULTS
In all 8 children, laparoscopy detected an anomaly at a site corresponding to that of the abdominal pain. Findings were adhesions in 7 children (3 colonic, 2 ileocecal, 1 gastric, and 1 appendiceal) and ovarian torsion in 1 child. At a mean follow-up of 12.6 months, the abdominal pain had completely resolved in 6 children, notably improved in 1 child, and continued unchanged in 1 child. Disability completely resolved in 2 of 3 children.


CONCLUSIONS
In children with unexplained abdominal pain that is acute in onset, well described, and suggestive of peritoneal involvement, exploratory laparoscopy (1) successfully ends the cycle of abdominal pain in most cases; and (2) commonly identifies abnormalities, usually adhesions. However, whether laparoscopy, the placebo effect, or both promote the healing process is unclear. Further study is needed to develop criteria for referral for laparoscopic evaluation of unexplained abdominal pain.
Hoffenberg
E J
EJ
Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.
Rothenberg
S S
SS
Bensard
D
D
Sondheimer
J M
JM
Sokol
R J
RJ
D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D000293:Adolescent; D002648:Child; D006233:Persons with Disabilities; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006801:Humans; D010535:Laparoscopy / Q000191:economics; D008297:Male; D015990:Placebo Effect; D016896:Treatment Outcome