Table 1.
Summary table of most common etiologies of acute non-traumatic abdominal pain in pediatric population.
| Etiology | Demographics | Risk Factors | Treatment | Prognosis | Imaging Findings |
|---|---|---|---|---|---|
| Intussusception | Estimated incidence 74 per 100,000 with M:F ratio3:2. Most common at 9–24 months | Viral gastroenteritis, rotavirus vaccine, Meckel diverticulum, duplication cysts, lymphomas, HSP, cystic fibrosis, celiac, Crohn disease. | Hydrostatic or pneumatic reduction, surgery for complicated cases. | Excellent with early diagnosis and treatment. May recur. | “target” and “pseudo-kidney” signs on US |
| Pyloric Stenosis | Around 2 to 3.5 per 1000 with male predominance (M:F 4:1 to 6:1). Rarely after 12 weeks of age | Preterm birth, maternal smoking, family history, maternal erythromycin and azithromycin use. | Pyloromyotomy | Excellent with early diagnosis and treatment. | Pyloric muscle thickness >3mm on US |
| Intestinal malrotation / midgut volvulus | 1 in 6000 live births. Estimated M:F 2:1 in neonates. Most before 1 year of age | Congenital diaphragmatic hernia, Congenital heart disease, Omphalocele, Gastroschisis, Esophageal atresia. | Surgical(Ladd procedure) | High mortality in volvulus. | Corkscrew appearance on upper GI series. |
| Acute Appendicitis | Incidence 19 to 28 per 10,000 children younger than 14. Slight male predominance and in second decade of life. | Nonspecific obstruction of the appendiceal lumen, lymphoid hyperplasia | Appendectomy | Excellent with surgery. | enlarged appendix, non-opacified lumen and significant contrast enhancement on CT |
| Testicular Torsion | 1 in 4000 males. Peaks in neonatal period and puberty. | Previous torsion, family history of torsion. | Orchiopexy if viable. Orchiectomy if nonviable testis. | Detorsion within 6 hrs –viable. Nonviable after 24 hrs. | Enlarged testicle with diminished flow on US. Whirlpool sign. |
| Ovarian Torsion | Estimated at 4.9 per 100,000 females. Most commonly at onset of reproductive age. |
Ovarian cysts, masses, prior torsion, strenuous exercise. | Surgical Detorsion | Prompt treatment may prevent irreversible ischemic damage | Enlarged edematous ovary with peripheral displacement of follicles. Twisted vascular pedicle. Diminished /absent blood flow on US |
| Renal Stones | Estimated range 36 to 57 per 100,000 children. Boys more commonly affected in 1stdecade, girls in second. Ages 12–17 years. | Congenital/structural abnormalities, infection, metabolic disease, dehydration, immobilization, medications. | Supportive care, treat underlying abnormalities, medical expulsive therapy, urologic intervention | Generally good prognosis. | Stone visualization on US or CT |