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.     

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.     

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.     

儿童周期性呕吐综合征临床特征及预后随访

目的　分析儿童周期性呕吐综合征（CVS）临床表现、辅助检查、治疗及预后,以期提高对儿童周期性呕吐综合征的认识和诊治水平。方法　回顾性分析重庆医科大学附属儿童医院消化科2008年1月至2019年12月住院且符合儿童功能性胃肠病ROME Ⅳ诊断标准的141例CVS患儿临床资料及随访结果。结果　141例患儿中男65 例、女76例,发病年龄中位数5.5岁（≤15岁5月龄）,诊断年龄中位数8.3岁（11月龄至15岁8月龄）,首次发病至确诊病程平均2.3年（3个月至11.3年）,平均住院4次。其中60.28%（85/141）有明确诱因,感染与饮食不当最常见。所有病例均有呕吐,发作持续时间中位数为5 d（2～14 d）,平均每日呕吐发作约15次,间歇期中位数38 d（5 d至6 个月）。其他症状包括腹痛（72.34%,102/141）、恶心（46.81%,66/141）、头晕（30.50%,43/141）、发热（26.24%,37/141）、头痛（19.86%,28/141）、便秘（19.15%,27/141）。所有病例急性期均予以补液等对症支持治疗,发作间期予以赛庚啶、普萘洛尔、西比灵等药物预防治疗,88例随访1~10年,81例（92%）治疗有效,9例仍有头痛表现（其中1例外院诊断偏头痛）,13例有腹痛表现。结论　CVS是儿童呕吐的常见病因之一,各年龄段均可发病,无明显性别差异,发作前通常有诱因且临床诊断常有延迟;CVS可反复发作,除呕吐外常有其他消化道或自主神经紊乱相关症状;对于发作频率高、持续时间长的患儿预防应用赛庚啶、普萘洛尔、西比灵等药物多数有效;该组CVS患儿流行病学、临床表现及疗效与其他地区相似,但随访偏头痛、腹痛发生率明显低于国外数据。     

小儿急性阑尾炎的诊治体会

目的 探讨儿童急性阑尾炎的诊治特点。方法 回顾1998年6月～2003年6月期间四川大学华西医院收治的940例小儿急性阑尾炎临床资料，总结其临床特点及处理经验。结果 本组940例，发热、腹痛、右下腹固定压痛及白细胞升高为最主要表现，939例经手术及病理检查证实诊断，术后均痊愈，其中18例有白血病、血液系统疾病及其他原发疾病的患儿，确诊后也经手术治疗痊愈。另1例有原发白血病的患儿经内科治疗缓解后离院，预后不详。结论 发热、腹痛、右下腹固定压痛及白细胞升高仍是诊断小儿急性阑尾炎的最主要依据，并且小儿阑尾炎一经诊断应尽早处理，年龄越小，越应积极手术。对合并其他原发疾病的阑尾炎患儿，在充分准备的情况下仍可进行外科治疗，以防严重并发症发生。     

Appendicitis in childhood: usefulness of ultrasound in diagnosis

The decision to perform ultrasonography (US) in children with suspected appendicitis must ultimately be made by the surgeon or pediatrician. Children with a high clinical likelihood of appendicitis are unlikely to benefit from sonographic evaluation. US is likely to be most beneficial when the clinical findings are indeterminate, both to establish the diagnosis of appendicitis and to aid in the diagnosis of other causes of acute abdominal pain. When US of the right lower quadrant is negative for appendicitis, pelvic US should be performed in female patients to exclude acute gynecologic disorders. A sonographic survey of the upper abdomen is also mandatory to diagnose other disorders causing acute abdominal pain.     

Advancements in the diagnosis of acute appendicitis in children and adolescents.

The aim of our study was to further improve the preoperative diagnosis of acute appendicitis in children and adolescents. All diagnostic parameters from the patients' medical history (duration and quality of abdominal pain, stool behaviour), the laboratory (leukocytes, C-reactive protein), the clinic (defense, tenderness on percussion, nausea, vomiting, dry tongue) and repeated ultrasound investigations (visualisation of the appendix, indirect signs of an inflammatory process in the appendix region) were documented prospectively and were re-assessed with regard to their diagnostic value. As an additional parameter, procalcitonin was determined. 1156 patients (593 male/563 female) with a mean age of 9.51 years (+/- 1.2 yrs) (max. 15 yrs/min. 2.3 yrs), referred to the department with acute abdominal pain, were examined. 233 (141 male/92 female; 20.1 %) of these patients with a mean age of 10.47 years (+/- 1.1 yr) had appendicitis. Based on the patients' medical history, laboratory findings, the initial clinical investigation and the initial ultrasound investigation, 173 patients (74.3 % of the later operated 233 children with appendicitis) were diagnosed with certainty. The diagnosis of 60 patients (25.7 %) of this group remained uncertain. These patients received a saline enema (Clysmol, Pharmacia & Upjohn Company) and were subjected to a second clinical and sonographic investigation after approximately four hours of parenteral fluid substitution (Ringer's lactate, Mayrhofer Pharmazeutika Company, 4 ml/kg/h). The other 923 patients (79.83 %) were discharged and were followed up as outpatients in the following days. Based on this stepwise procedure, the percentage of correctly diagnosed appendicitis could be increased to 97.4 %. The measurement of procalcitonin proved to be of no value in the diagnosis of acute appendicitis. It may be concluded that in children with abdominal pain, high diagnostic accuracy can only be achieved by a carefully combined evaluation of all individual diagnostic parameters and repeated investigations.     

Primary peritonitis in previously healthy children

In a review of 22 years of clinical experience, we found seven previously healthy children with primary peritonitis. The diagnosis was made at laparotomy in all patients. Their symptoms included diffuse abdominal pain, fever, vomiting, and diarrhea. Abdominal tenderness was maximal in the right lower quadrant in five children, which led to confusion with the diagnosis of acute appendicitis. Streptococcus pneumoniae was identified as the etiologic agent in three patients and group A beta-hemolytic Streptococcus in one patient. The remaining three patients all had prior antibiotic therapy, and peritoneal fluid cultures were sterile. All children had a prompt response to treatment with antibiotics and recovered without complications. Long-term follow-up (4 1/2 to 15 years) was available for three patients; all three remained healthy.     

Appendizitis

Appendicitis is the most frequent intraabdominal disease requiring surgical intervention. The clinical presentation can vary from acute abdominal pain to unspecific symptoms such as loss of appetite, fever, nausea and vomiting. The age of maximum frequency for appendicitis is between 6 and 12 years. Diagnosing acute appendicitis can be particularly challenging in young children, where symptoms are uncharacteristic and perforation can occur rapidly. The main factors influencing the outcome of appendicitis include accurate diagnosis followed by appendectomy prior to appendix perforation. Factors contributing to an almost 100% survival rate and a significant reduction in postoperative complications and long-term morbidity include the use of ultrasound and CT, anesthesia and surgical techniques especially suited to children, pediatric intensive care, as well as peri- and postoperative antibiotic therapy.     

Primary omental torsion in children

Objective : A retrospective review was conducted to establish the prevalence and clinical features of omental torsion or infarction as a cause of acute abdominal pain in childhood.
Methodology : The case records were analysed for all patients admitted with primary omental pathology to the Department of General Surgery, Royal Children's Hospital, Melbourne, between January 1975 and July 1994.
Results : From 1975 to 1994 (20 years) 13 children were admitted to our General Surgical Department with primary omental disease. There were nine males and four females under 16 years of age. The presenting complaint was abdominal pain with vomiting or diarrhoea. Four children had major medical conditions. Pre-operative diagnosis in all cases was acute appendicitis. Appendicectomy and omentectomy were performed without complication in all cases. Histology of the omentum demonstrated torsion, infarction or haemorrhage.
Conclusions : All children presented with features of acute appendicitis, a majority were male, and two out of the 13 patients were obese. The absence of any children under 4 years was consistent with the relative paucity of omental fat in younger children. We found no clear mechanism for primary omental torsion, although rotation around the right epiploic artery was observed.     

Appendicular colic and the non-inflamed appendix: fact or fiction?

AIMS: Appendicoliths cause acute appendicitis and appendicular perforation. Do appendicoliths cause acute abdominal pain in the absence of acute appendicitis? METHODS: A retrospective observational study was undertaken of histology reports of all appendicectomy specimens from children < 16 years of age between January 1995 and December 2001. Specimens were categorised as perforated or uncomplicated acute appendicitis, non-inflamed, and "incidental" (removed during abdominal surgery for other indications). The presence of an appendicolith was noted. Clinical details were supplemented by selected case note review. Specimens in which the diagnosis of appendicitis or the presence of an appendicolith were not clearly defined (n = 20) were reviewed by an experienced, independent pathologist. RESULTS: 601 consecutive appendicectomy reports were analysed. The mean age of the study population was 9 years (range 1 day - 15.9 years) and there were 357 boys. An appendicolith was identified in 31/118 (26%) cases of perforated appendicitis, 60/352 (17%) cases of uncomplicated appendicitis, 12/59 (20%) cases of non-inflamed appendices, and only 1/72 (1%) cases of incidental appendicectomies. All patients with an appendicolith in the non-inflamed appendix group had presented with acute abdominal pain mimicking acute appendicitis. The frequency of an appendicolith in perforated appendicitis was significantly greater than in uncomplicated acute appendicitis (chi (2) = 4.8, 1 df, p < 0.05). There was no significant difference in the frequency of an appendicolith between non-inflamed appendices and acute appendicitis (either perforated or intact). Appendicoliths were rarely found in incidental appendicectomies, but these patients were younger. The frequency of appendicoliths in non-inflamed appendices was much greater than that expected from published autopsy data. CONCLUSION: Appendicoliths may cause acute abdominal pain that mimics acute appendicitis.     

The management of acute abdominal pain in children

Objective : Acute abdominal pain is a common problem in childhood, and appendicitis is frequently diagnosed by general practitioners and doctors working in emergency departments. The objective of the present report was to determine the frequency of appendicitis in a group of children with acute abdominal pain presenting to the emergency department of a general hospital, as well as attempting to analyse the manner in which these patients were managed.
Methodology : The initial assessment in hospital (by resident hospital staff) of the study group of patients was analysed and their subsequent clinical progress documented.
Results : The present report shows that the vast majority of children with acute abdominal pain do not have appendicitis and that appendicitis is significantly over-diagnosed by junior hospital doctors.
Conclusions : Appendicitis is a clinical diagnosis, best made by an experienced member of the paediatric surgical team. Frequent review, with a minimum of investigations, provides the best means of making a rational decision regarding surgery.     

Oxycodone vs placebo in children with undifferentiated abdominal pain: a randomized, double-blind clinical trial of the effect of analgesia on diagnostic accuracy

BACKGROUND: Analgesics for children with acute abdominal pain are often withheld for fear that they might mask physical examination findings and thus might be unsafe. This viewpoint has been challenged recently. OBJECTIVE: To evaluate the effects of buccal oxycodone on pain relief, physical examination findings, diagnostic accuracy, and final clinical outcomes in children with acute abdominal pain. DESIGN: Prospective, randomized, double-blind, and placebo-controlled trial between December 2001 and November 2003. SETTING: University teaching hospital in Finland.Patients A total of 104 children aged 4 to 15 years with abdominal pain of less than 7 days' duration were screened, and 63 children with pain scores of 5 or higher on a 10-cm visual analog scale were eligible for the trial.Intervention Children were randomized to receive buccally either 0.1 mg/kg(-1) of oxycodone hydrochloride (n = 32) or the same volume of normal saline (n = 31). The same surgeon described the physical findings and indicated a provisional diagnosis and a provisional disposition before the children received the study medication and at 1 hour and 3.5 hours after initial dosing. Pain scores were recorded at baseline and every 30 minutes for 3.5 hours after the first study drug administration. MAIN OUTCOME MEASURES: Pain intensity difference, presence or absence of abdominal guarding, and diagnostic accuracy. RESULTS: The demographic characteristics, initial pain scores, and physical signs and symptoms were similar between the 2 groups. Both study drugs were associated with decreasing pain scores. The summed pain intensity difference over 7 observations was significantly greater in the oxycodone group, 22 +/- 18 cm, than in the placebo group, 9 +/- 12 cm (mean difference 13 cm, with a 95% confidence interval of 2-24 cm; P = .04). The diagnostic accuracy increased from 72% to 88% in the oxycodone group and remained at 84% in the placebo group after study drug administration. Laparotomy was performed in 17 patients in the oxycodone group and in 14 patients in the placebo group. Four patients without appendicitis underwent exploratory laparotomy in each group. One patient in the placebo group was initially diagnosed as having nonspecific abdominal pain, but at 14 hours, she was operated on for appendiceal perforation. CONCLUSIONS: Early administration of buccal oxycodone provides a significant pain relief to children with acute abdominal pain, without adversely altering the clinical signs or obscuring the surgical diagnosis.     

Pediatric appendicitis in "real-time": the value of sonography in diagnosis and treatment.

OBJECTIVES: To determine the accuracy of sonography in the diagnosis of clinically equivocal appendicitis, and to identify the factors leading to an inaccurate ultrasound diagnosis. The impact of sonographic findings on clinical management and outcome of children with appendicitis is examined. METHODS: We performed a retrospective review of 317 children who attended the emergency department (ED) of a children's hospital for acute abdominal pain for which acute appendicitis was the main differential diagnosis. They had ultrasound because the diagnosis was uncertain clinically. RESULTS: The positive predictive value of ultrasound for appendicitis was 0.92, and the negative predictive value was 0.88. The sensitivity and specificity could not be determined because there were 43 patients with equivocal ultrasound results. The pitfalls hindering the accuracy of ultrasound diagnosis included a high incidence of perforated appendicitis at presentation, the retrocecal appendix, and other technical factors such as abdominal guarding, excessive bowel gas, obesity, inadequate bladder filling, and the uncooperative patient. When ultrasound findings were combined with clinical judgment in clinical management, there were only five cases of non-therapeutic laparotomy and eight cases of delayed surgery due to missed diagnosis in our cohort. CONCLUSIONS: Ultrasound is a useful for the evaluation of acute abdominal pain in children. However, in the setting of a pediatric hospital ED, the accuracy of ultrasound and its ability to improve early hospital triage may be reduced. Repeated clinical review is still essential and in selected cases, appendiceal CT scan may be required to guide therapeutic decision making.     

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.     

Diagnostic performance of contrast-enhanced MR for acute appendicitis and alternative causes of abdominal pain in children

Objective

Unenhanced MRI has emerged as a useful tool for diagnosing pediatric acute appendicitis. The use of contrast-enhanced MRI for diagnosing pediatric appendicitis has not been documented. The purpose of this study is to examine the diagnostic performance of contrast-enhanced MRI for acute appendicitis and alternative entities in the pediatric population presenting with acute abdominal pain.

Materials and methods

A retrospective review was conducted of 364 consecutive pediatric patients undergoing contrast-enhanced MRI for the evaluation of possible appendicitis at a single institution between November 2012 and September 2013.

Results

There were 132 cases of pathologically confirmed appendicitis out of 364 pediatric patients (36.3%) included in the study. Overall sensitivity and specificity were 96.2% (95% CI [91.4–98.4%]) and 95.7% (95% CI [92.3–97.6%]), respectively. Positive predictive value and negative predictive value were 92.7% (95% CI [86.6–96.3%]) and 97.8% (95% CI [94.7–99.1%]), respectively. The appendix was visualized in 243 cases (66.8%). Imaging confirmed alternative diagnoses in 75 patients, including most commonly colitis, enteritis or terminal ileitis (n?=?25, 6.9%), adnexal cysts (n?=?25, 6.9%) and mesenteric adenitis (n?=?7, 1.9%).

Conclusion

Contrast-enhanced MRI is capable of accurately diagnosing acute appendicitis while detecting many alternative entities of abdominal pain, and it allows good visualization of the appendix. Further evaluation is needed to determine whether contrast-enhanced MRI provides an advantage over non-enhanced MRI for imaging evaluation of acute abdominal pain in the pediatric population.     

Prospective evaluation of admission for acute abdominal pain in children

Acute abdominal pain (AAP) is one of the most frequent causes of admission to an emergency department of a childrens' hospital. The diagnosis viewed with the most apprehension is acute appendicitis. We present the results of a prospective study on the evaluation of the clinical and paraclinical symptoms generally observed in an AAP, and discuss the benefit of a diagnostic score for acute appendicitis. Twenty-five different diagnoses were observed, the 5 most frequent being: "non specific" (34.2%), constipation (16%), otorhinolaryngological infection (11.6%), gastroenteritis (10.7%) and acute appendicitis (10.5%). The study of 12 symptoms showed an elevated sensitivity for each one (92-50%), but a low positive predictive value (72-12%). Rigid adhesion to a diagnostic score would have led to unnecessary medical examination.     

Diagnosing pediatric appendicitis

Appendicitis is the most common surgical cause of abdominal pain in children, The diagnosis is fairly straightforward in a child with the classic history of epigastric or periumbilical pain followed by anorexia, nausea, or vomiting, with migration of pain to the right lower quadrant of the abdomen and low-grade fever. It is the child with an equivocal history or physical examination that provides the diagnostic challenge. The additions of ultrasonography and computed tomography to the radiologic evaluation has improved the clinician's ability to diagnose appendicitis, but the diagnosis is not always made.     

儿童胆道系统感染的诊断与治疗

儿童胆道系统感染包括急、慢性胆囊炎和胆管炎.急性胆囊炎主要表现为右上腹疼痛,呈持续性胀痛,Murphy征阳性,伴恶心、呕吐,部分患儿有高热、寒战、黄疸,重症者发生昏迷.急性胆管炎发病急骤,以腹痛、寒战、高热和黄疸三联征为临床特征,少数患儿以感染性休克为主要表现,病死率高.本文介绍儿童胆道系统感染的诊断与治疗.     

儿童急性胰腺炎的临床特征分析

目的 分析儿童急性胰腺炎的临床特点,为临床及时认识和早期诊治提供依据.方法 收集我院2003年3月至2009年12月,收治的121例儿童急性胰腺炎患儿,对其临床、生化、影像学及预后进行总结和分析.结果 121例学龄前和学龄儿童为主,发病高峰季节为5、6月份,临床首发症状主要为腹痛(88.4%)和呕吐(61.2%),1岁以下无腹痛主诉.70.2%有腹部压痛,可伴腹肌紧张、腹胀、肝大、黄疸等,严重者出现休克、抽搐、昏迷等.114例(94.2%)患儿入院24 h血淀粉酶升高,77例(79.4%)尿淀粉酶升高,发病后3 d血淀粉酶逐步下降,部分发病后14 d仍不能恢复正常.血淀粉酶持续增高和≥正常值上限3倍组患儿发热、呕吐、腹胀较多,胰腺B超或CT异常也较多,显示胰腺回声减低或增强、胰体增大、胰管扩张等.B超显示75例(62.0%)合并胰外损害,以肝脏和肠道表现为主,实验室检查肝功能异常和心肌损害较为常见,可有血清ALT或AST、总胆红素、血糖升高和心肌酶异常.部分胃镜检查显示胃黏膜充血、水肿和散在片状糜烂等.除1例剖腹探查术外,其余均非于术综合治疗,治愈好转119例,死亡2例,出院后复发5例.结论 儿童急性胰腺炎多以消化道症状为主,常合并胰外损害,婴儿腹痛主诉越少,提示临床不能解释的腹痛和呕吐患儿应考虑本病.动态监测血淀粉酶和影像学检查.

Abstract：

Objective To analyze the characteristics of children with acute pancreatitis and provide the basis of early diagnosis and treatment. Methods Totally 121 children with acute pancreatitis admitted to Hunan Children's Hospital between March 2003 and December 2009 were enrolled in this retrospective study. The data of clinical manifestations, biochemical examinations, imaging and prognosis were summarized and statistically analyzed. Results Of the 121 cases, preschool and school-age children were the main groups, and the prevalent months were May and June. Abdominal pain ( 88. 4% ) and vomiting (61.2%) were the major initial symptoms of pancreatitis in children, but none of children under the age 1year complained of abdominal pain; 70. 2% had signs of abdominal tenderness, accompanied by abdominal rigidity, distension, hepatomegaly, jaundice, etc. Severe patients developed shock, convulsions, coma and so on. Serum amylase concentration increased to above the upper reference limit in 114 children (94. 2% )when they admitted within 24 hours after admission. Urine amylase elevation was noted in 77 children(79.4%). The amylase concentration decreased after 3 days, but not all returned to normal 14 days afterward. Children with sustained serum amylase elevation or serum amylase level ≥ 3 times upper limit of normal range more likely to have fever, vomiting, abdominal distension, and pancreatic abnormalities at ultrasonography or CT which showed that the echo of pancreas decreased or enhanced, pancreas edema,pancreatic duct expanded, etc. Abdominal ultrasonography and CT showed that 75 cases ( 62. 0% ) had other organ damage besides pancreatitis, liver (25. 3% ) and intestinal (16. 0% ) damages were very common, while liver and myocardial damages were seen frequently in the laboratory examinations, which complicated with serum ALT/AST, total bilirubin, blood glucose elevation and myocardial enzyme abnormalities. Several gastroscopic examinations showed mucosal hyperemia and edema, sheet-like erosion,etc. Except for one case who underwent laparotomy, all the remaining children were treated with nonoperative comprehensive treatment. Of them 119 were cured or improved, 2 died and 5 had recurred disease later. Conclusions Gastrointestinal symptoms were the main clinical manifestations of acute pancreatitis in children, often complicated with extrapancreatic damage. The younger the patient was, the less complaint of abdominal pain they had. This indicates that acute pancreatitis should be considered when children suffered from acute abdominal pain and vomiting which had no known cause or could not be explained. It is important to do take serial monitoring of serum amylase, and imaging procedures.