Diagnosing abdominal pain in a pediatric emergency department.

We undertook a prospective study of 377 children (two to 16 years old) presenting with abdominal pain to determine: 1) common discharge diagnoses; 2) what signs and symptoms are associated with appendicitis; and 3) follow-up of patients discharged from the emergency department (ED). Nine diagnoses accounted for 86% of all diagnoses made. The most common final diagnosis was "abdominal pain" (36%). The following findings were significantly associated with appendicitis: vomiting, right lower quadrant(RLQ) pain, tenderness, and guarding (all P less than 0.001). Ninety-seven percent (28/29) of patients with appendicitis had at least two of these four signs and symptoms, as did 28% (96/348) of patients without appendicitis. The sensitivity of the model is 0.96, and the specificity is 0.72 (positive predictive value = 0.24; negative predictive value = 0.99). Of the patients contacted within one week of the visit (237), 75% reported that the pain had resolved (mean contact time, 2.6 days). We conclude that 1) patients presenting to the ED with abdominal pain often leave with the diagnosis of abdominal pain; 2) of the patients contacted, the majority reported that their pain has resolved; and 3) a diagnosis of appendicitis should be considered in any patient with any two of the following signs or symptoms: vomiting, guarding, tenderness, or RLQ pain. Such patients should be evaluated and observed carefully for the possible diagnosis of appendicitis.     

Clinical spectrum of acute abdominal pain in Turkish pediatric patients: A prospective study

Abstract Background : The aim of the present study was to determine the prevalence, associated symptoms, and clinical outcomes of children with acute abdominal pain who had been admitted to an emergency department. Methods : Children aged between 2 and 16 years who presented to the emergency department of Cerrahpa?a Medical School, Istanbul University between July 2001 and August 2002 with acute abdominal pain were enrolled in this study. A questionnaire was completed each patient admitted to our pediatric emergency unit for acute abdominal pain. Data collected included presenting signs and symptoms, the hospital follow up for all children who returned within 10 days, test results, and telephone follow up. Results : The number of children referred to the emergency department was 7442, with 399 (5.4%) of these having acute abdominal pain. The mean age of the study population was 6.9 ± 3.5 years, and 201 of the patients were male. The five most prevalent diagnoses were: (i) upper respiratory tract infection and/or complicated with otitis media or sinusitis (23.7%); (ii) abdominal pain with uncertain etiology (15.4%); (iii) gastroenteritis (15.4%); (iv) constipation (9.4%); and (v) urinary tract infection (8%). The most common associated symptoms were decreased appetite, fever and emesis. Because of follow‐up deficiency the progress of 28 patients was not obtained. Eighty‐two children were referred to the department of pediatric surgery, but only 17 of 82 (20.7%) required surgical intervention (15 of these 17 for appendicitis). Eleven patients returned within 10 days for re‐evaluation, but the initial diagnosis was not changed. The complaints of 57 patients with uncertain etiology were resolved within 2 days. Conclusions : An acute complaint of abdominal pain was usually attributed to a self‐limited disease. However, the percentage of surgical etiology is not negligible.     

Diagnosing appendicitis in children with acute abdominal pain

Differentiating acute appendicitis from other causes of acute abdominal pain in children frequently remains unsatisfactory. To determine whether initial historical and physical examination findings might predict final diagnoses, 246 patients with complaints of nontraumatic and nonrecurrent acute abdominal pain were studied. All were between three and 18 years of age and had presented to a hospital-based pediatric emergency department. Each family was telephoned an average of 5.1 days after the visit to determine the patient's subsequent clinical course; operative notes and pathology reports were reviewed for patients receiving surgery. Of these patients with acute abdominal pain, both fever and vomiting were present in 18 of the 24 who eventually had diagnoses of appendicitis, compared with 49 of 222 patients with other final diagnoses (P less than 0.01, with negative predictive value 0.97, sensitivity 0.75, and specificity 0.78, but positive predictive value only 0.27). The duration of the pain at presentation and the frequency of other symptoms (eg, diarrhea, dysuria, anorexia, and lethargy) were unrelated, however, to final diagnosis, as was the duration of the pain and whether abdominal tenderness initially was localized or generalized. Nonruptured appendicitis was generally indistinguishable from ruptured appendicitis preoperatively, by both duration and symptoms. Boys were found more likely to have appendicitis (with or without rupture) than girls (18/118 or 15%, vs. 6/128 or 5%, P less than 0.05). In conclusion, fever and vomiting were noted at presentation more frequently in children with appendicitis than in children with other causes of acute abdominal pain.(ABSTRACT TRUNCATED AT 250 WORDS)     

Determining the common medical presenting problems to an accident and emergency department

All accident and emergency (A&E) attendances over a one year period were prospectively studied in order to determine common medical presenting problems. Data were collected on children (0-15 years) attending a paediatric A&E department in Nottingham between February 1997 and February 1998. A total of 38 982 children were seen. The diagnoses of 26 756 (69%) were classified as trauma or surgical, and 10 369 (27%) as medical; 1857 (4%) could not be classified. The commonest presenting problems reported for "medical" children were breathing difficulty (31%), febrile illness (20%), diarrhoea with or without vomiting (16%), abdominal pain (6%), seizure (5%), and rash (5%). The most senior doctor seeing these patients in A&E was a senior house officer (intern or junior resident) in 78% of cases, paediatric registrar (senior resident) in 19%, consultant (attending physician) in 1.4%, and "other" in 2.6%. Guidelines developed for A&E should target the commonest presenting problem categories, six of which account for 83% of all medical attendances, and be directed towards senior house officers.     

Determining the common medical presenting problems to an accident and emergency department.

All accident and emergency (A&E) attendances over a one year period were prospectively studied in order to determine common medical presenting problems. Data were collected on children (0-15 years) attending a paediatric A&E department in Nottingham between February 1997 and February 1998. A total of 38 982 children were seen. The diagnoses of 26 756 (69%) were classified as trauma or surgical, and 10 369 (27%) as medical; 1857 (4%) could not be classified. The commonest presenting problems reported for "medical" children were breathing difficulty (31%), febrile illness (20%), diarrhoea with or without vomiting (16%), abdominal pain (6%), seizure (5%), and rash (5%). The most senior doctor seeing these patients in A&E was a senior house officer (intern or junior resident) in 78% of cases, paediatric registrar (senior resident) in 19%, consultant (attending physician) in 1.4%, and "other" in 2.6%. Guidelines developed for A&E should target the commonest presenting problem categories, six of which account for 83% of all medical attendances, and be directed towards senior house officers.     

Malrotation in children with symptoms of gastrointestinal allergy and psychosomatic abdominal pain

Three children with malrotation 4.5, 5 and 9 years old at operation are presented. Their preliminary diagnoses were gastrointestinal (GI) allergy, GI allergy with colon irritable and psychosomatic abdominal pain. They were treated on an outpatient basis under these diagnoses for more than two years before their malrotations were discovered. In two children radiology did not demonstrate any signs of intestinal obstruction and in one of these children repeated radiological examinations were necessary for the diagnosis of malrotation. Operative findings were chronic volvulus with compromised blood flow and obstructive duodenal bands. The third child suffered acute strangulation ileus with gangrene of the intestines before diagnosis was made. We conclude that special consideration must be given to the possibility of malrotation when treating and radiologically investigating children with GI disturbances.     

Malrotation in Children with Symptoms of Gastrointestinal Allergy and Psychosomatic Abdominal Pain

Three children with malrotation 4.5, 5 and 9 years old at operation are presented. Their preliminary diagnoses were gastrointestinal (GI) allergy, GI allergy with colon irritabile and psychosomatic abdominal pain. They were treated on an outpatient basis under these diagnoses for more than two years before their malrotations were discovered. In two children radiology did not demonstrate any signs of intestinal obstruction and in one of these children repeated radiological examinations were necessary for the diagnosis of malrotation. Operative findings were chronic volvulus with compromised blood flow and obstructive duodenal bands. The third child suffered acute strangulation ileus with gangrene of the intestines before diagnosis was made. We conclude that special consideration must be given to the possibility of malrotation when treating and radiologically investigating children with GI disturbances.     

The spectrum and frequency of illness presenting to a pediatric emergency department

Knowledge of the spectrum and relative frequencies of pediatric emergencies is an important factor in developing appropriate training curricula for physicians treating children in emergency departments. To provide these data, we reviewed the records for four one-week periods (January, April, July, and October) of a large pediatric emergency department to describe the population in terms of age, chief complaints, diagnoses, time of arrival, seasonal variation, and disposition. There were 3796 log entries. Complete information on all variables was obtained on 3784 patients. Age ranged from one day to 39 years, and the mean age was 6.0 +/- 6.15 years. One half of all emergency department visits were by children three years old or younger. On the other hand, 12% of visits were by adolescents (ages 13 to 18), and one in 25 visits was made by an adult (greater than 18 years old). The majority of chief complaints and final diagnoses were related to infection and trauma. More than half of the patients arrived on the evening shift, between 4 pm and 12 am. Eleven percent of the children seen on day and evening shifts and 13% from the night shift were admitted. From the analysis of our data we recommend expanded skills in the management of minor trauma for pediatric residents, an emphasis on management of infections for nonpediatric emergency specialists, and extensive training in both pediatric and adult trauma for physicians in pediatric emergency medicine fellowships.     

Appendicitis in children less than 3 years of age: a 28-year review

Appendicitis is the most common surgical abdominal emergency in the pediatric population, but is rarely considered in children less than 3 years of age. The goal of this study was to identify the presenting symptoms and signs in this age group and examine their subsequent management and outcome. A 28-year experience of a single pediatric surgeon in academic practice was reviewed; 27 children less than 3 years old (mean 23 months) comprised 2.3% of all children with appendicitis in his series. The most common presenting symptoms were vomiting (27), fever (23), pain (21), anorexia (15), and diarrhea (11). The average duration of symptoms was 3 days, with 4 or more days in 9 children. Eighteen children were seen by a physician before the correct diagnosis was made; 14 were initially treated for an upper respiratory tract infection, otitis media, or a urinary tract infection. The most common presenting signs were abdominal tenderness (27), peritonitis (24), temperature 38.0 °C or more (21), abdominal distension (18), Leukocytosis (<12.0 × 10³/mm³) was found in 18, tenderness was localized to the right lower quadrant (RLQ) in 14 and was diffuse in 10. Abdominal radiographs demonstrated findings of a small-bowel obstruction (SBO) in 14 of 21 patients, a fecalith in 2, and a pneumoperitoneum in 1. Contrast enemas were performed in 6 children, 5 of whom had a phlegmon or an abscess. Perforated appendicitis was found in all 27 patients. An appendectomy was performed in 25 and a RLQ drain was placed in 18. Postoperative antibiotics were administered to 17 children for an average of 6 days. Two patients underwent interval appendectomies, 1 following treatment with IV antibiotics and 1 following surgical drainage. The average time to resume oral intake was 7 days and the average hospital stay was 21 (median 15) days. Sixteen patients had 22 complications, which included 6 wound infections, 4 abscesses, 4 wound dehiscences, 3 pneumonias, 2 SBOs, 2 incisional hernias, and 1 enterocutaneous fistula. Perforated appendicitis was found in all children less than 3 years old, resulting in very high morbidity (59% complications), which may be attributed to the 3–5-day delay in diagnosis. Although appendicitis is uncommon in this age group, it should be seriously considered in the differential diagnosis of children under the age of 3 years who present with the triad of abdominal pain, tenderness, and vomiting.     

Acute abdomen in children due to extra-abdominal causes

Background: Acute abdominal pain in children is a common cause for referral to the emergency room and for subsequent hospitalization to pediatric medical or surgical departments. There are rare occasions when the abdominal pain is derived from extra-abdominal organs or systems. The aim of the present study was to establish the most common extra-abdominal causes of acute abdominal pain.
Methods: The notes of all children (1 month–14 years of age) examined for acute abdominal pain in the Accident and Emergency (A&E) Department of Alexandroupolis District University Hospital in January 2001–December 2005 were analyzed retrospectively. Demographic data, clinical signs and symptoms, and laboratory findings were recorded, as well as the final diagnosis and outcome.
Results: Of a total number of 28 124 children who were brought to the A&E department, in 1731 the main complaint was acute abdominal pain. In 51 children their symptoms had an extra-abdominal cause, the most frequent being pneumonia ( n  = 15), tonsillitis ( n  = 10), otitis media ( n  = 9), and acute leukemia ( n  = 5).
Conclusion: Both abdominal and extra-abdominal causes should be considered by a pediatrician who is confronted with a child with acute abdominal pain.     

儿童腹胀的临床特点及病因分析

目的 探讨不同年龄儿童腹胀的临床特点及病因,为临床诊疗提供帮助。方法 回顾性分析2013年1月至2016年10月以腹胀为主诉入院的1 561例患儿的临床表现、影像学检查、病理结果及疾病诊断等临床资料。结果 1 561例患儿中,新生儿（< 28 d）823例,婴儿（28 d~）307例,幼儿（1岁~）186例,学龄前儿童（3岁~）120例,学龄儿童（6岁~）106例,青春期（12~17岁）19例。新生儿组、婴儿组、幼儿组及学龄组伴随症状均以呕吐为主,学龄前组以腹痛为主,青春期组以呕吐、腹痛为主。新生儿组和婴儿组伴随体征以肠鸣音减弱为主,其余各年龄组以腹部压痛为主。新生儿组腹部平片以肠道充气扩张为主,其余各年龄组以肠道充气扩张伴液气平为主。339例患儿完善组织病理学检查,其肠组织病理结果为：新生儿组以肠黏膜下神经节细胞体积小、数量少或发育差为主,婴儿组以肠道炎症、出血、坏死为主,其余各年龄组以阑尾炎为主。新生儿组以坏死性小肠结肠炎为腹胀主要病因（34.4%）;婴儿组、幼儿组、学龄前组、学龄组及青春期组均以肠梗阻为主要病因,分别占36.8%、52.2%、51.7%、62.3%、52.6%。结论 呕吐为各年龄组腹胀患儿较常见的症状;腹胀新生儿及婴儿多表现为肠鸣音减弱,1岁以上患儿以腹部压痛为主。坏死性小肠结肠炎是新生儿腹胀最常见的病因,其余年龄组患儿多以肠梗阻作为主要病因。     

Childhood cholelithiasis in a district hospital

Cholelithiasis is a rare finding in children, even though recent series show increased detection of this disease. A retrospective study was performed in children with a diagnosis of cholelithiasis between 1993 and 2005 in the Reina Sofia Hospital in Tudela (Spain). Eighteen patients with cholelithiasis and three with biliary sludge were detected. Predisposing factors for cholelithiasis were prematurity and parenteral nutrition (one patient), sepsis (two patients), obesity (one patient), and a family history of the disease (one patient). The disease was idiopathic in 11 patients. Gallstones were detected in two patients presenting with appendicular symptoms. One child with biliary sludge had received treatment with ceftriaxone as a predisposing factor. All patients were diagnosed by ultrasound. Plain abdominal X-ray detected lithiasis in 12 of the 15 patients (80 %) with cholelithiasis who underwent this procedure. The most frequent symptoms were abdominal pain (seven patients), abdominal pain and vomiting (five patients), and diarrhea (one patient). Two patients presented with appendicular symptoms. Fourteen patients underwent surgery (open cholecystectomy in two and laparoscopic cholecystectomy in 12). None of the patients required emergency surgery. Cholelithiasis in children is an unusual finding, but is not exceptional and is associated with nonspecific symptoms. Plain abdominal X-ray is useful in diagnosis but the main diagnostic technique is ultrasonography.     

The impact of recurrent abdominal pain: predictors of outcome in a large population cohort

AIM: Recurrent abdominal pain is one of the commonest complaints of childhood, affecting approximately 10% of children at any one time. This study aims to describe the outcome of recurrent abdominal pain amongst 6-year-old children, and to identify risk factors (in both the children and their parents), which predict these outcomes. METHODS: 7128 6-year-old children in the Avon Longitudinal Study of Parents and Children (ALSPAC) were followed up for 1 year. The principle outcomes were abdominal pain, number of days missed from school in the preceding year and psychiatric diagnoses. RESULTS: Children with recurrent abdominal pain at age 6 years had higher rates of further abdominal pain [odds ratio 4.88 (95% CI: 4.01, 5.95)], school absence (10 or more days off school in a year) [OR 1.89 (1.53, 2.33)] and anxiety disorders [OR 2.36 (1.68, 3.32)] at age 7 years. Maternal anxiety was the most consistent predictor of subsequent adverse outcomes for these children. CONCLUSION: Children with recurrent abdominal pain are at significant and continuing risk of adverse functioning. It is important for clinicians to take a whole family perspective, and particularly to consider parental anxiety, when a child with recurrent abdominal pain presents to them.     

Back pain in children who present to the emergency department.

The purpose of this study was to identify the causes and epidemiology of back pain in children who present to the emergency department. All children who presented to an urban pediatric emergency department (ED) during a 1-year period with the chief complaint of back pain were examined and evaluated with a uniform questionnaire. This was completed at the time of the ED visit in 48%, and within 48 hours in 52%. During a 1-year period, 225 children with a complaint of back pain were evaluated. The mean age was 11.9 +/- 4 years and 60% were female. Onset was acute (< or = 2 days) in 59%, and chronic (> or = 4 weeks) in only 11.6%. Pain awakened children from sleep in 47%, and caused 52% to miss school or work. The most common diagnoses were direct trauma (25%), muscle strain (24%), sickle cell crises (13%), idiopathic (13%), urinary tract infection (5%), and viral syndrome (4%). Radiographs of the back were rarely helpful. About 5% required hospital admission; one half of these were attributed to sickle cell crises. We conclude that back pain is an uncommon reason for children to present to an emergency department. When present, pediatric back pain is most often musculoskeletal, associated with an acute infectious illness or a traumatic event. Although the etiology is rarely serious, back pain often affects the daily activities of symptomatic children.     

An epidemiological survey of recurrent abdominal pain in a rural Malay school

OBJECTIVE: To study the prevalence of complaints of recurrent abdominal pain (RAP) among school children aged 11-12 years in a rural setting in Malaysia. METHODOLOGY: Questionnaires were distributed to all parents and teachers of children aged 11-12 years who attended a small rural school in which all the children were Malays. Complaints of RAP were defined as at least three such complaints occurring over a period of at least 3 months. RESULTS: One hundred and sixty questionnaires were distributed, of which 148 were returned, giving a response rate of 92.5%. Sixty-one children (41.2%) had RAP. Approximately 45.2% of girls and 35.9% of boys reported having RAP. Compared with children without RAP, there was a significantly larger number of children with RAP (85.2%) who had at least one stress factor (P = 0.0109). There were no significant associations between RAP and total family income (P = 0.0573), a history of abdominal pain in at least one parent (P = 0.1686), a history of abdominal pain in at least one sibling (P = 0.0617), academic performance (P = 0.9967) or the degree of sports participation (P = 0.8469). There was an increased incidence of other systemic complaints in children with RAP when compared with children without RAP. CONCLUSION: Recurrent abdominal pain was found to be common among 11- to 12-year-old children in a rural Malay school. There was a significant association found between RAP and the presence of stressful events, as well as with the presence of other systemic complaints.     

Emergency Management of Acute Abdomen in Children

Acute abdomen can be defined as a medical emergency in which there is sudden and severe pain in abdomen with accompanying signs and symptoms that focus on an abdominal involvement. It accounts for about 8 % of all children attending the emergency department. The goal of emergency management is to identify and treat any life-threatening medical or surgical disease condition and relief from pain. In mild cases often the cause is gastritis or gastroenteritis, colic, constipation, pharyngo-tonsilitis, viral syndromes or acute febrile illnesses. The common surgical causes are malrotation and Volvulus (in early infancy), intussusception, acute appendicitis, and typhoid and ischemic enteritis with perforation. Lower lobe pneumonia, diabetic ketoacidosis and acute porphyria should be considered in patients with moderate-severe pain with little localizing findings in abdomen. The approach to management in ED should include, in order of priority, a rapid cardiopulmonary assessment to ensure hemodynamic stability, focused history and examination, surgical consult and radiologic examination to exclude life threatening surgical conditions, pain relief and specific diagnosis. In a sick patient the initial steps include rapid IV access and normal saline 20 ml/kg (in the presence of shock/hypovolemia), adequate analgesia, nothing per oral/IV fluids, Ryle’s tube aspiration and surgical consultation. An ultrasound abdomen is the first investigation in almost all cases with moderate and severe pain with localizing abdominal findings. In patients with significant abdominal trauma or features of pancreatitis, a Contrast enhanced computerized tomography (CECT) abdomen will be a better initial modality. Continuous monitoring and repeated physical examinations should be done in all cases. Specific management varies according to the specific etiology.     

Acute appendicitis in children under 3 years of age. Diagnostic and therapeutic problems

Aim: Analysis of diagnostic and therapeutic problems in acute appendicitis in children below 3 years of age. Material and methods: The analysis was based on medical data of 53 children under 3 years of age, treated in our department for acute appendicitis in the years 1988-2008. Among 53 children, 29 (53.7%) were admitted directly to the surgical department and 24 (45.3%) were transferred from the regional pediatric department. In the period of 1 month before admission to the surgical department 13 patients (24.5%) were treated as outpatients due to acute respiratory or alimentary tract infection. On the basis of the data from the case histories, the most frequent symptoms and their duration were evaluated, as well as the clinical signs, intraoperative diagnosis and the postoperative course. Results: The most frequent symptoms and clinical signs in this group of children were: abdominal pain, vomiting and fever, present in 83.0%, 75.5%, and 67.0% patients respectively. The mean time of the symptoms' duration was 3.6 days. The most frequently found physical signs on admission to the surgical ward were: abdominal pain on palpation, increased tonus of abdominal muscles and abdominal distension. On laparotomy gangrenous appendicitis was found in 49% of the children operated. In 24.5% of patients perforation of the appendix was confirmed. Further complications occurred in 9 children (16.9%). The average stay in hospital after the operation lasted 7.9 days. Conclusions: 1. Acute appendicitis in small children is a diagnostic problem not only for primary health care doctors but also for experienced pediatricians and pediatric surgeons. 2. Early surgical consultation should be a standard procedure in small children with acute symptoms of various locations when there is accompaning abdominal pain, not reacting to conservative treatment. Surgical consultation is also indicated in children under 3 years of age with relapses of abdominal pain. 3. Clinical signs of appendicitis in children aged less than 3 years, may differ from those in older children due to changes in their immunological reactivity. This problem should be included in under-graduate and post-graduate medical studies.     

以腹痛为主要表现的消化道疾病与幽门螺杆菌关系的探讨

为探讨以腹痛为主要表现的消化道疾病与幽门螺杆菌（Hp)感染的关系,对289例腹痛患儿采用日产富士能410PE电子胃镜检查,并取胃窦部粘膜组织进行病理学检查及Hp检测,结果：其病变检出率100％,Hp平均感染率38．8％－4岁,－7岁,－10岁,－14岁各年龄组Hp感染率分别为20．0％,33．3％,37．5％,42．0％,Hp在十二指肠溃疡,慢性浅表胃炎,十二指肠球炎中感染率分别为73．1％,36．0％,31．0％,说明Hp感染率随着年龄的增加而增高,同时,Hp感染又是儿童慢性胃炎,消化性溃疡的重要因素。     

Clinical and laboratory findings in 220 children with recurrent abdominal pain

Aim: To investigate the clinical and laboratory findings in children with recurrent abdominal pain (RAP). Methods: Consecutive patients with RAP (Apley criteria), age 4–16 years, referred to a secondary medical centre were evaluated by a standardized history, physical examination and laboratory tests. The tests encompassed Helicobacter pylori (Hp), gastrointestinal bacterial infections, protozoa, coeliac disease, carbohydrate malabsorption, food intolerance, abdominal ultrasound and plain abdominal X‐ray. More investigations were obtained if indicated. Patient characteristics were compared with surgical patients without abdominal pain (control group). Results: A total of 220 consecutive patients were included (92 M, mean age 8.8 years [4.1–16.0 years]). In 88% of the patients, abnormalities were found that refer to possible causes. Especially, protozoa were present in 33% of the patients, mostly Dientamoeba fragilis, Yersinia enterocolitica in 12% and endoscopically proven infection with Hp in 11%. In 36%, a plain abdominal X‐ray raised suspicion of constipation. Conclusion: In 220 consecutive patients with RAP, referred to secondary care, a standardized work‐up yielded abnormal results in a high percentage. The clinical significance of these findings remains to be established.     

Intussusception in children of school age

BACKGROUND: There are only a few reports discussing the characteristics of intussusception developing in school-age children. The characteristics of these cases are discussed, with reference to previous literature. METHODS: The present study included eight cases of intussusception in school-age children among 143 intussusception patients treated on an inpatient basis at Nihon University Itabashi Hospital, during the 11 year period from 1993 to 2003. The remaining 135 patients were assigned to the infant group as controls. The clinical characteristics of intussusception in school-age children were compared with those of the condition developing in infants. RESULTS: The eight children of school age with intussusception ranged in age from 8 to 15 years (mean, 11.6 years), and consisted of five boys and three girls. The major symptom was abdominal pain, occurring in 100% (8/8). Bloody stools and vomiting were reported in two patients each (25%) from this group. The triad of abdominal pain, bloody stools and vomiting was recognized in only one child (12.5%) of this group. Two children (25.0%) had a palpable abdominal mass, and one child (12.5%) complained of diarrhea. None of the school-age children with intussusception had any antecedent infection; five, two and one patients had the ileo-colic type, ileo-ileo-colic type and ileo-ileal type of intussusception, respectively. Four underwent enema reduction and four underwent surgical reduction. One of the eight children (12.5%) had underlying organic abnormality; in the remaining children the condition was labeled idiopathic. One child developed recurrences. CONCLUSIONS: In school-age children intussusception is generally believed to be commonly secondary to underlying organic abnormality, but in the present study only one of eight school-age children had underlying organic abnormality; in the remaining children, the condition was labeled idiopathic. The major symptom in school-age intussusception was abdominal pain. Therefore this may need to be differentiated from appendicitis in children of school age. It is considered that abdominal ultrasonography (USG) is a simple and useful method for making the diagnosis of intussusception, and that diagnostic USG should be conducted in all school-age children presenting with acute abdominal pain.