Paediatric, Abdominal Pain (Acute Non-Traumatic)
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Population Covered By The Guidance
This pathway provides guidance on imaging a child with non-traumatic abdominal pain.
Date reviewed: July 2014
Date of next review: July 2023
Published: July 2014
Quick User Guide
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The relative radiation level of each imaging investigation is displayed in the pop up box.
SYMBOL | RRL | EFFECTIVE DOSE RANGE | |
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None | 0 | |
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Minimal | < 1 millisieverts | |
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Low | 1-5 mSv | |
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Medium | 5-10 mSv | |
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High | >10 mSv |
Images
Teaching Points
Teaching Points (Acute non-traumatic abdominal pain)
- The imaging modality of choice is dependant on the clinical history and examination, as well as the most likely differential diagnosis with the age of the child in mind
- In infants with vomiting, consideration should be given to bowel obstruction or hypertrophic pyloric stenosis (HPS). In the first case plain radiography/contrast enhanced upper GI study is indicated. In HPS an ultrasound is recommended
- In older infants, intussusception should be considered. Ultrasonography is the imaging modality of choice
References
References
References are graded from Level I to V according to the Oxford Centre for Evidence-Based Medicine, Levels of Evidence. Download the document
- Strouse PJ. Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 2004;34:837-51. (Review article)
- McAlister WH, Kronemer KA. Emergency Gastrointestinal Radiology of the Newborn. Rad Clinic North Am. 1996;34:819-44. (Review article)
- del-Pozo G, Albillos JC, Tejedor D, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics. 1999;19:299-319. (Review article)
- Strouse PJ. Imaging and the child with abdominal pain. Singapore Med J. 2003;44:312-22. (Review article)
- Ratcliffe JF, Fong S, Cheong I, O'Connell P. The plain abdominal film in intussusception: the accuracy and incidence of radiographic signs. Pediatr Radiol. 1992;22:110-11. (Level III evidence)
- Sargent MA, Babylon P, Alton DJ. Plain abdominal radiography in suspected intussusception: a reassessment. Pediatr Radiol. 1994;24:17-20. (Level III evidence)
- Eklöf O, Hartelius H. Reliability of the abdominal plain film diagnosis in pediatric patients with suspected intussusception. Pediatr Radiol. 1980;9:199-206. (Level II evidence). View the reference
- Meradji M, Hussain SM, Robben SGF, Hop WCJ. Plain film diagnosis in intussusception. Br J Radiol. 1994;67:147-9. (Level III evidence)
- Strouse PJ. Disorders of intestinal rotation and fixation ("malrotation"). Pediatr Radiol. 2004;34:837-51. (Review article)
- Buonomo C. Neonatal gastrointestinal emergencies. Radiol Clin North Am. 1997;35:845-64. (Review article)
- Jolley SG. Gastroesophageal reflux disease as a cause for emesis in infants. Semin Pediatr Surg. 2005;4:176-89. (Review article)
- Alford BA, McIlhenny J. The child with acute abdominal pain and vomiting. Radiol Clin North Am. 1992;30:441-53. (Review article)
- Torres AM, Ziegler MM. Malrotation of the intestine. World J Surg. 1993;17:326-31. (Level III evidence)
- Wang GD, Liu SJ. Enema reduction of intussusception by hydrostatic pressure under ultrasound guidance: a report of 377 cases. J Pediatr Surg. 1988;23:814-8. (Level IV evidence)
- Bhisitkul DM, Listernick R, Shkolnik A, et al. Clinical application of ultrasonography in the diagnosis of intussusception. J Pediatr. 1992;121:182-6. (Level II evidence). View the reference
- Lim HK, Bae SH, Lee KH, Seo GS, Yoon GS. Assessment of reducibility of ileocolic intussusception in children: usefulness of color Doppler sonography. Radiology. 1994;191:781-5. (Level III evidence)
- del-Pozo G, Albillos JC, Tejedor D. Intussusception: US findings with pathologic correlation - the crescent-in-doughnut sign. Radiology. 1996;201:379-86. (Level II evidence). View the reference
- Verschelden P, Filiatrault D, Garel L, et al. Intussusception in children: reliability of US in diagnosis - a prospective study. Radiology. 1992;184:741-4. (Level III evidence)
- Holt S, Samuel E. Multiple concentric ring sign in the ultrasonographic diagnosis of intussusception. Gastrointest Radiol. 1978;3:307-9. (Level IV evidence)
- Montali G, Croce F, De Pra L, Solbiati L. Intussusception of the bowel: a new sonographic pattern. Br J Radiol. 1983;56:621-3. (Level IV evidence)
- Alessi V, Salerno G. The "hay-fork" sign in the ultrasonographic diagnosis of intussusception. Gastrointest Radiol. 1985;10:177-9. (Level IV evidence)
- Meyer SE. The current radiologic management of intussusception: a survey and review. Pediatr Radiol. 1992;22:323-5. (Level IV evidence)
- Zerin JM, DiPietro MA. Superior mesenteric vascular anatomy at US in patients with surgically proved malrotation of the midgut. Radiology. 1992;183:693-4. (Level III evidence)
- Dufour D, Delaet MH, Dassonville M, Cadranel S, Perlmutter N. Midgut malrotation, the reliability of sonographic diagnosis. Pediatr Radiol. 1992;22:21-3. (Level III evidence)
- Shimmanuki Y, Aihara T, Takano H, et al. Clockwise whirlpool sign at color Doppler US: an objective and definite sign of midgut volvulus. Radiology. 1996;199:261-4. (Level III evidence)
- Hayden CK, Boulden TF, Swischuk LE, Lobe TE. Sonographic demonstration of duodenal obstruction with midgut volvulus. AJR Am J Roentgenol. 1984;143:9-10. (Level IV evidence)
- Weinberger E, Winters WD, Liddell RM, Rosenbaum DM, Krauter D. Sonographic diagnosis of intestinal malrotation in infants: importance of the relative positions of the superior mesenteric vein and artery. AJR Am J Roentgenol. 1992;159:825-8. (Level III evidence)
- Sivit CJ, Applegate KE, Stallion A, et al. Imaging evaluation of suspected appendicitis in a pediatric population: effectiveness of sonography versus CT. AJR Am J Roentgenol. 2000;175:977-80. (Level III evidence)
- Kaiser S, Frenckner B, Jorulf HK. Suspected appendicitis in children: US and CT - a prospective randomized study. Radiology. 2002;223:633-8. (Level III evidence)
- Lowe LH, Penney MW, Stein SM, et al. Unenhanced limited CT of the abdomen in the diagnosis of appendicitis in children: comparison with sonography. AJR Am J Roentgenol. 2001;176:31-5. (Level III evidence)
- Franken EA Jr, Kao SC, Smith SC, Sato Y. Imaging of the acute abdomen in infants and children. AJR Am J Roentgenol. 1989;153:921-8. (Review article)
- Braffman BH, Coleman BG, Ramchandani P, et al. Emergency department screening for ectopic pregnancy: a prospective US study. Radiology. 1994;190:797-802. (Level II evidence). View the reference
- Barnhart K, Mennuti MT, Benjamin I, et al. Prompt diagnosis of ectopic pregnancy in an emergency department setting. Obstet Gynecol. 1994;84:1010-5. (Level II evidence)
- Gracia CR, Barnhart KT. Diagnosing ectopic pregnancy: decision analysis comparing six strategies. Obstet Gynecol. 2001;97:464-70. (Level II evidence). View the reference
- Wong TW, Lau CC, Yeung A, et al. Efficacy of transabdominal ultrasound examination in the diagnosis of early pregnancy complications in an emergency department. J Accid Emerg Med. 1998;15:155-8. (Level II evidence)
- Sadek AL, Schiotz HA. Transvaginal sonography in the management of ectopic pregnancy. Acta Obstet Gynecol Scand. 1995;74:293-6. (Level II evidence)
- Kaplan BC, Dart RG, Moskos M, et al. Ectopic pregnancy: prospective study with improved diagnostic accuracy. Ann Emerg Med. 1996;28:10-7. (Level II evidence)
- Ginai AZ. Experimentation evaluation of various available contrast agents for use in the gastrointestinal tract in case of suspected leakage: effects on peritoneum. Br J Radiol. 1985;58:969-78. (Level III evidence)
- Stein M, Alton DJ, Daneman A. Pneumatic reduction of intussusception: 5-year experience. Radiology. 1992;183:681-4. (Level IV evidence)
- Meyer JS, Dangman BC, Buonomo C, Berlin J. Air and liquid contrast agents in the management of intussusception: a controlled, randomised trial. Radiology. 1993;188:507-11 (Level II/III evidence). View the reference
- Daneman A, Navarro O. Intussusception. Part 2: an update on the evolution of management. Pediatr Radiol. 2004;34:97-108. (Review article). View the reference
- Irish MS, Shellnut JK, Bovet PM, Grewal H. Pediatric intussusception surgery. Updated:April 14,2011. Accessed: March 06,2012. View the reference
- Kitagawa S, Miqdady M. Intussusception in children. In: UpToDate, Basow, DS (Ed),UpToDate,Waltham, MA, 2012.
- Bramson RT, Meyer TL, Silbiger ML, Blickman JG, Halpern E. The futility of the chest radiograph in the febrile infant without respiratory symptoms. Pediatrics. 1993; 92(4):524-6. (Level III evidence)
- Patterson RJ, Bisset GS 3rd, Kirks DR, Vanness A. Chest radiographs in the evaluation of the febrile infant. AJR Am J Roentgenol. 1990;155(4):833-5. (Level III evidence)
- Neuman MI, Monuteaux MC, Scully KJ, Bachur RG. Prediction of pneumonia in a pediatric emergency department. Pediatrics. 2011;128(2):246-53. (Level III evidence) .
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Consent to Procedure or Treatment Radiation Risks of X-rays and Scans |
Radiation Risk of Medical Imaging for Adults and Children Paediatric Abdominal Ultrasound Children's (Paediatric) X-ray Examination |
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