The following are the main surgical diseases that cause abdominal pain in children.
I. Pediatric acute intussusception
Etiology: most of the causes of pediatric acute intussusception are due to the consequences of intestinal dysfunction caused by viral and bacterial infections, and a few are caused by congenital intestinal malformations, tumors and other abdominal organic lesions.
Physical examination of acute intussusception: at the onset of the disease, a mass of variable location can be palpated in the abdomen. The mass is usually curved or salami-shaped. Anal finger examination may reveal blood or blood-tinged mucus. The longer the duration of symptoms, the greater the amount of bleeding. Children with prolonged obstruction may develop dehydration and bacteremia, leading to tachycardia and fever, and occasionally hypovolemic or infectious shock. Untimely treatment can be fatal.
Treatment is divided into conservative and surgical treatment. The majority of children who are seen in time are cured by conservative treatment. Some children with late presentation require surgical treatment to cure. Intussusception due to organic abdominal pathology also requires surgery to resolve the original pathology in order to cure.
Incarcerated hernia
What we often call “stuck” hernia is medically called “incarcerated hernia”, the primary cause of incarcerated hernia is pediatric inguinal hernia, also called “pediatric hernia”. The primary cause of an incarcerated hernia is a pediatric inguinal hernia, also known as a pediatric hernia. It is a common complication of pediatric hernia. Some children with no history of hernia may also present with an “incarcerated hernia” as the first symptom.
The clinical manifestations of an incarcerated hernia include a painful mass in the groin or scrotum when a pediatric hernia becomes incarcerated. The child may suddenly cry or point his finger at the mass to indicate pain, and soon the symptoms of intestinal obstruction such as nausea, vomiting, cessation of defecation and exhaustion may occur. On examination, the doctor finds a bulging, hard and painful mass in the inguinal region, which cannot be returned to the abdominal cavity. If there are bloody stools and signs of poisoning, intestinal necrosis may appear, which is the most serious complication. Neonatal hernias have their own peculiarities and are not easy to detect, sometimes they are only manifested as inability to feed or vomit or they are seen as intestinal obstruction. In some cases, the intestinal canal and the ipsilateral testicle are found to be necrotic during surgery and have to be removed.
Once a pediatric hernia is “stuck”, it should be taken to the hospital immediately. The treatment can be divided into two types: manual repositioning and surgical treatment.
Pediatric appendicitis
The peak incidence of pediatric acute appendicitis is between the ages of 6 and 12 years, and is less common in children under 5 years of age and even less common in children under 1 year of age. The onset of pediatric appendicitis is seasonally related, with a high incidence of appendicitis in March and April, when there are many upper respiratory tract infections, and in July and August, when there is a high incidence of gastroenteritis.
Clinical manifestations of pediatric appendicitis.
1, abdominal pain: due to difficulties in history taking and narration, a typical history of metastatic abdominal pain is often not obtained, the abdominal pain is more extensive, and sometimes the abdominal pain is not the first symptom.
2. Gastrointestinal symptoms: often obvious and prominent. Vomiting is often the first symptom, and the vomiting is heavy and long-lasting, and may produce dehydration and acidosis due to massive vomiting and inability to eat. Sometimes diarrhea can occur, constipation is rare.
3, systemic symptoms: more serious, the early appearance of fever, up to 39-40 ℃, and even the emergence of plug war, high fever, convulsions, convulsions, which is due to the instability of the central temperature of young children and the inflammatory response is intense.
4, pressure pain and muscle tension: pressure pain points are mostly in the right lower abdomen above the McKinsey point. Infants and young children with high appendix position and mobility, its pressure pain point is partial internal upper, the abdominal wall of children is thin and less cooperative, it is not easy to determine whether there is muscle tension. Should be patient, gentle and careful examination, and up and down, left and right for comparative examination.
5, upper respiratory tract symptoms: the incidence of upper respiratory tract infections in pediatric patients is high, and these diseases may be a trigger for the development of pediatric acute appendicitis. Therefore, pediatric patients often have upper respiratory tract diseases before the clinical manifestations of acute appendicitis.
Pediatric acute appendicitis has the following characteristics.
1. Weak defenses of the pediatric organism, due to deficiencies in humoral immune function, lack of complement and poor phagocytosis of neutrophils, coupled with unstable thermoregulatory function. As a result, hyperthermia is likely to occur, leukocyte elevation is more pronounced than in adults, and toxic symptoms are more severe.
2, the clinical symptoms of acute appendicitis in older children are similar to those in adults, and infants under 6 years of age often lack the typical symptoms of metastatic right lower abdominal pain, and the abdominal pain and painful signs are often variable, so the clinical misdiagnosis rate is high, with 63% reported.
3, septic, perforation fast: pediatric appendiceal lymphatic tissue is rich, appendiceal wall is very thin, less muscle layer tissue, inflammation after lymphedema serious, can cause appendiceal cavity obstruction, blood flow obstruction, so easy to perforation. The younger the age, the higher the incidence of perforation, and after perforation, diffuse peritonitis is formed, and it is difficult to form limited abscess by adhesion, which is due to the incomplete development of large omentum and perforation too fast. Perforation can occur in septic appendicitis at 14-24h of onset.
In contrast, diagnosis is difficult when the young age cannot accurately express the nature of abdominal pain and cooperate with physical examination. Treatment is based on the principle of early detection and early treatment, and surgery should be performed once the diagnosis is clear. Some atypical appendicitis can only be diagnosed after consultation with an experienced specialist.
Chronic appendicitis is also common in children, mostly in older children aged 7-12 years, and is thought to be a residual condition after the acute appendicitis has subsided. If there is a typical history of an acute appendicitis episode followed by persistent or recurrent right lower abdominal pain without other positive signs, chronic appendicitis is highly likely. Chronic appendicitis is often triggered by acute attacks due to strenuous activity, prolonged walking and poor diet. Some chronic appendicitis only presents with atypical symptoms such as loss of appetite, epigastric discomfort, nausea after rising in the morning, and acid reflux. There is some difficulty in diagnosis.
In conclusion, the causes of abdominal pain in children are complex and the clinical manifestations are varied, so do not take painkillers and all kinds of adult stomach medicines indiscriminately to avoid delaying the condition and missing the best time for treatment, resulting in adverse consequences. The most scientific is to go to the hospital in time.