[Diagnostic difficulties in pediatric abdominal pain with potential appendicitis].
BACKGROUND
Pediatric abdominal pain is one of the most common symptom of children brought to attention of primary care physicians and pediatric surgeons. In many children clinical symptoms may be uncharacteristic and may lead to diagnostic difficulties.


OBJECTIVE
Clinical analysis of children with right lower quadrant abdominal pain suspected of appendicitis or children with periappendicular mass.


METHODS
The histories of 14 children aged from 18 months to 17 years treated in Pediatric Clinic were analysed. All children were operated because of right lower quadrant abdominal pain or abdominal mass before admission to the Pediatric Clinic or during hospitalization in Pediatric Clinic. Intraoperatively in all children pathologies other than appendicitis were the cause of symptoms.


RESULTS
The most often Crohn's disease were recognized (9 children), in 2 cases with concomitant other pathologies (fecal tumor of appendix in one case and with peritoneal abscess after perforation of intestinal wall). Sporadically the inflammation of the mesenterial lymph nodes caused by Yersinia infection suggested appendicitis. In one boy with ulcerative colitis, during exacerbation of the disease appendicitis complicated by rupture and peritonitis was observed. In 18-month old child with right lower quadrant abdominal mass invagination complicated by perforation of the ileum was recognized. In the case of 14-years old boy 6 months after appendectomy we observed mechanical intestinal obstruction complicated by perforation and peritonitis. Carcinoid of the appendix was the cause of abdominal pain in one child.


CONCLUSIONS
1. Appendicitis is the most frequent surgical etiology of the right lower quadrant pediatric abdominal pain. 2. Despite new diagnostic imagines there are no definite criteria to recognize appendicitis, in most cases physical examination and very carefull evaluation of abdominal pain are the most important. 3. All children with periappendipected of Crohn's disease. 4. All children with equivocal presentations of appendicitis and with normal appendix during operation should undergo further diagnostic evaluation.
Iwańczak
Barbara
B
II Katedra i Klinika Pediatrii, Gastroenterologii i Zywienia Akademii Medycznej im. Piastów Slaskich we Wrocławiu.
Stawarski
Andrzej
A
Czernik
Jerzy
J
Bronowickip
Krzysztof
K
Iwańczak
Franciszek
F
Pytrus
Tomasz
T
Klempous
Jan
J
Godziński
Jan
J
D015746:Abdominal Pain / Q000209:etiology*; D000293:Adolescent; D001064:Appendicitis / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male