Clinical spectrum and surgical implications of acute non-traumatic abdominal pain in childhood at Kenyatta national hospital

Abstract

Introduction: The diagnosis and management of acute abdominal pain forms a large part of the routine duties of physicians and surgeons. History and physical examination by themselves provide the diagnosis in two-thirds of the cases'" 2, 11). The assessment and diagnosis of acute abdominal pain in childhood continues to be a clinical challenge (2,3) and not only does the aetiology and incidences of the conditions vary over the paediatric age spectrum but also vary over the different indigenous populations'!", Awareness of the common surgical causes of acute abdominal pain over the paediatric age groups in this locality will improve the diagnostic accuracy and therefore the management of these patients. Objectives: The primary objective was to determine the spectrum of acute abdominal pain in patients 13 years and below in the study locality with the aim of enhancing the understanding of the surgically relevant acute abdominal pain and improving the diagnostic accuracy. Materials and methods: This was a cross-sectional observational prospective study in the Paediatric Filter Clinic and the paediatric wards in Kenyatta National Hospital. Patients 13 years and below presenting to the casualty department with acute non-traumatic abdominal pain were seen and followed up in the respective wards if admitted. A questionnaire was completed for each patient seen with acute abdominal pain. The data collected was analyzed in accordance with the objectives of the study. Results: Three hundred and ninety patients were enrolled for the study. Males constituted 62.4%and females 37.6% with a mean age of 4.3 years. One hundred and thirty one patients (33.6%) were admitted and 74 of these (56.5%) underwent surgery. Fifty percent of the patients presented within 36 hours of onset of the abdominal pain. Surgical causes constituted a 14% of all cases seen in casualty. The commonest cause of surgical abdominal pain in those less than one year was intussusception (25.7%) while appendicitis, commonly seen in children of six years and above, contributed to 30% and intestinal obstruction 14.9%.Overall medical causes were leading as causes of acute abdominal pain with upper respiratory tract infections contributing the majority (21%) while gastroenteritis contributed to 15.9% and non-specific abdominal pain 9.2%.Mortality was low at 1.5%. Conclusions: The causes of AAP in the paediatric age group vary with the age. Medical causes are the leading in our locality but important and life threatening surgical causes must be recognized and diagnosed appropriately with timely intervention to avoid complications. History and physical examination remain the cornerstones in the approach to a patient with acute abdominal pain. Knowledge and experience of the examiner remain critical to successful management.