Abdominal pain among children re-evaluation of a diagnostic algorithm

Table 1 Algorithm for diagnosis of abdominal pain

	Abdominal Pain
Acute abdomen		Non-acute abdomen
(long time pain definite signs)		(short pain no definite sign)
1 Focal inflammation	2 Intestinal obstruction	1 Primary enterospasm
		(allergic, idiopathic)
(1) local tenderness	(1) intestinal pattern	(1) weaning colic
(appendicitis, etc.)	(adhesive obstruction)
(2) tender mass	(2) movable mass	(2) school-boy colic
(torsion ovarian cyst)	(intussusception)
3 generalized peritonitis		2 secondary enterospasm
(full and silent abdomen)		(organic, non-acute)
(1) spreading peritonitis	(2) gangrenous peritonitis	(1) chronic G-I ulcers
(inflamed organ)	(strangulation)	(2) pancreticobiliary colic
(3) perforating peritonitis	(4) primary peritonitis	(3) chronic gastritis
(peptic ulcer, typhoid)	(bacteremia, vaginitis)	(4) cerebrospinal colic
		(5) hemo-vascular disease
		(6) metabolic disease
		(7) auto-immue disorder
		(8) intoxication

*Footnote: (1) "comparative technique" of abdominal palpation, watching different reaction of the child on different part of abdomen. (2) "dynamic comparison" of clinical presentation, is today better or worse than yesterday?

Table 2 Came with abdominal pain to emergency ward, BCH, 2000

Category	n	%
Organ inflammationa	637	65.5
Intestinal obstructionb	160	16.5
Traumatic abdomen	28	2.9
GI hemorrhage	38	3.9
Primary peritonitis	5	0.5
Perforation peritonitis	8	0.8
Tumor twisting or rupturing	14	1.4
Torsion testes or appendage	8	0.8
Other organic lesion	5	0.5
Non organic pain	70	7.2
Total	973	100.0

^a Included 614 appendicitis

^bIncluded 57 intussusception

Table 3 Outcome of 973 cases of acute abdominal pain admitted to surgical emergency ward in 2000

Outcome	n	%
Cure	894	91.9
Improveda	67	6.9
Unimproveda	11	1.1
Died	1	0.1
Total	973	100.0

^aMost are chronic traumatic, inflammatory, and malignancy cases with acute pain

Table 4 Number of operated patients of common surgical abdomen, 2000

Disease	n	%
Acute appendicitis	614	68.0
Intussusceptiona	57	6.3
Incarcerated hernia	45	5.0
Traumatic abdomen	28	3.1
Adhesive obstruction	25	2.8
Fecalith obstruction	19	2.1
Miscellaneous	115	12.7
Total	903	100.0

^aThe other 90% of early cases cured in OPD by rectal insufflation

Table 5 Pathology of 614 cases of operated appendicitis (2000)

Pathology	Simple	Suppurative	Gangrenous	Perforative	Recurrent	Abscess	Infiltrative	Total
Cases	166	254	7	103	38	42a	4	614
%	27.0	41.4	1.1	16.8	6.2	6.8	0.7	100.0

^aSimple drainage only