Abdominal Pain From Abdominal Scars

Abdominal Pain From Abdominal Scars

Adhesive small bowel obstruction occurs in 2-15% of children following a laparotomy. Seventy five percent of such patients present with adhesive obstruction between 2 weeks and 3 months after their operation. Eighty percent will occur within 2 years of operation. The disorder is treated with nasogastric decompression.

Postoperative intussusception occurs most commonly after major abdominal operations. Usually it is seen around age 26 months, but any age child may be affected. Postoperative intussusception presents with emesis, increased nasogastric drainage, abdominal distention, and irritability. Severe colicky pain and bloody stools are unusual. Ninety percent of the patients present within 2 weeks following surgery. Postoperative intussusception is managed with repeat laparotomy.
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Meckel Diverticulum

Meckel diverticulum are present in 2% of the population. It presents as a tender left lower quadrant mass, associated with blood in the stool. Occasionally, technetium nuclear scans are positive for Meckel’s in the symptomatic patient.

Vague abdominal pain with hemoccult positive stools suggests a Meckel Diverticulum. Bleeding is seen in 35-40% of childhood cases. RLQ pain, suggestive of appendicitis, is the usual complaint of children with bleeding.

Meckel diverticulum may cause intestinal obstruction or diverticulitis, which cannot be distinguished from appendicitis.

Pancreatitis
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Pancreatitis is a rare cause of abdominal pain in children. Trauma is the most frequent cause of this disorder in children.

Symptoms include mid-epigastric abdominal pain, nausea and vomiting, jaundice, and acholic stools.

Signs include epigastric tenderness, abdominal distention, decreased bowel sounds, and an epigastric mass may be detected.

An elevated serum amylase or serum lipase level is diagnostic.
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Abdominal x-ray may show an epigastric sentinel loop or pancreatic calcifications. US is very sensitive and shows an enlarged, hypoechoic pancreas. A pseudocyst or an enlarged pancreatic duct may also be seen.
Abdominal Pain

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