Plan

Overall Plan. The vast majority of children with abdominal pain have self-limited conditions that will resolve without medical treatment and thus require only reassurance. It is more important to ascertain whether surgery is required than to arrive at a precise preoperative diagnosis. If findings are equivocal, a period of observation or further imaging studies can be helpful. Surgical Intervention. Children identified with acute surgical abdominal conditions should undergo surgery without delay.

1. Preoperative measures. These can be instituted while the operating room is being prepared and include IV hydration, broad-spectrum antibiotics, and, if there is obstruction or significant vomiting, NG suction.

2. Volvulus and torsion. Midgut volvulus and ovarian torsion require the most urgent surgery, because even a brief delay can result in necrosis.

3. Appendicitis. Almost all children with appendicitis should undergo surgery promptly. An exception is the relatively few in whom perforation occurred days ago and who present with a walled off, well-localized infection without peritonitis. In such cases, broad-spectrum antibiotics and possible percutaneous drainage (if there is an abscess), followed by an interval appendectomy 6-8 weeks later, may lower the complication rate.

4. Intussusception. In most children with intussusception, the intestine can be reduced with air or liquid contrast by an experienced radiologist; if unsuccessful, surgery is required.

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