A. The 14-month-old boy with abdominal pain had ileocolic intussusception, seen on an air-contrast enema. It was successfully reduced and he was discharged the following day.
B. The 15-year-old girl with right lower quadrant abdominal pain underwent ultrasonography, which showed normal ovaries and an acutely inflamed appendix that was subsequently removed.
VII. Teaching Pearl: Question. Why does the pain in most children with appendicitis start out centrally and then "move" to the right lower abdomen?
VIII. Teaching Pearl: Answer. The initial pain in appendicitis is caused by distention. Stretch receptors in the wall of the appendix transmit through the same visceral nerves that supply the T10 dermatome, located around the umbilicus. As the inflammation progresses to involve the serosa, the parietal peritoneum transmits somatic pain, which is well localized to the site of the appendix, usually the right lower quadrant.
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