title: Recurrent severe abdominal pain in the pediatric patient.
abstract: BACKGROUND
  Ureteropelvic junction obstruction (UPJO) is a blockage occurring at the junction of the ureter and the renal pelvis. Pediatric patients with UPJO pose a diagnostic challenge when they present to the emergency department (ED) with severe recurrent abdominal pain if there is not a level of suspicion for this condition.
  
  
  OBJECTIVE
  Our aim was to review presentation of UPJO to the ED, methods of diagnosis, and treatment of this common but often overlooked condition.
  
  
  METHODS
  We report on 2 patients, a 9-year-old and 3-year-old, who had multiple presentations to health care providers and the ED with intermittent and recurrent abdominal pain. Subsequent testing, including ultrasound (US) and computed tomography (CT) with diuretic-recreated symptoms, revealed UPJO. Open pyeloplasty was performed, resulting in complete resolution of symptoms.
  
  
  CONCLUSIONS
  UPJO is an important diagnosis to consider when patients present to the ED with recurrent abdominal pain. US can be helpful in suspecting the diagnosis, but often CT, magnetic resonance urography, or diuretic scintigraphy is required for confirmation. Diuretics can be used to aid diagnostic testing by reproducing abdominal pain at the time of imaging. Referral to a urologist for open pyeloplasty is definitive treatment for this condition.
authors.affiliation: Department of Pediatrics and Emergency Medicine, Mayo Clinic, Rochester, Minnesota.
authors.forename: James L
authors.initials: JL
authors.lastname: Homme
authors.affiliation: Department of Emergency Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: Foster
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D012008:Recurrence; D014517:Ureteral Obstruction / Q000150:complications / Q000175:diagnosis*
keywords: abdominal pain; emergency department; hydronephrosis; pediatrics; ureteropelvic junction obstruction