EM · Paediatric abdominal emergencies

Paediatric abdominal emergencies — intussusception, volvulus, appendicitis and pyloric stenosis

Also known as Intussusception · Midgut volvulus · Malrotation · Paediatric appendicitis · Infantile hypertrophic pyloric stenosis · The acute abdomen in children

Paediatric abdominal emergencies — the four surgical conditions an ACEM Fellow must distinguish at the bedside: intussusception (3 months to 2 years, intermittent colicky pain with drawing up of the legs, a palpable sausage-shaped RUQ mass and redcurrant-jelly stool as a late sign, ultrasound target/donut sign, pneumatic or ultrasound-guided enema reduction with 80 to 90 per cent success and approximately 10 per cent recurrence), midgut volvulus from malrotation (bilious vomiting in the newborn and infant, never normal, upper GI contrast or ultrasound whirlpool sign, the time-critical Ladd procedure), atypical paediatric appendicitis (diffuse pain and diarrhoea in the under-5, over 50 per cent perforation at presentation, the Samuel Pediatric Appendicitis Score reproduced, ultrasound first), and infantile hypertrophic pyloric stenosis (projectile non-bilious vomiting at 3 to 6 weeks, palpable olive, hypochloraemic hypokalaemic metabolic alkalosis with paradoxical aciduria, correct chemistry before Ramstedt pyloromyotomy). Common management thread — weight-based 0.9 per cent saline plus KCl, nasogastric decompression, surgical referral — distinguished from the medical mimics of constipation, UTI and mesenteric adenitis. ACEM-primary, globally tagged.