Value of ultrasound in the assessment of acute abdomen in the pediatric age group

Bayan Rasool  Hama; Salwa Ahmed  Al- Najjar

doi:10.56056/amj.2023.229

Authors

Bayan Rasool Hama MBCHB. High Diploma Candidate of Radiology/Hawler Medical University- College of Medicine
Salwa Ahmed Al- Najjar Ass. Prof. MBCHB –DMRB-PHD (diagnostic radiology)/ Hawler Medical University- College of Medicine

DOI:

https://doi.org/10.56056/amj.2023.229

Keywords:

Acute abdomen, Children, Emergency room, Ultrasound

Abstract

Background & objectives: Acute abdominal pain in pediatric age groups is the most common presentation in an emergency room. The study aimed to diagnose cases of pediatric acute abdomen based on the ultrasound findings and determine the value of ultrasound in decision-making.

Methods: A cross-sectional prospective study was conducted in the Raparin Hospital in Erbil City/Iraq from Feb 2021 to June 2022. A convenience sampling method was used, and 200 patients who complained of acute abdominal pain were included in the study. The questionnaire was designed for data collection. A specialist pediatrician clinically examined the children; investigations were done then referred to the radiology department for an ultrasound examination.

Results: The ages of the involved cases ranged from one month to 15 years. Among them, 56.0% were males compared to 44.0% females, with a male-to-female ratio of 1.27:1. Regarding provisional clinical diagnosis of the patients, 60.0% presented with gastrointestinal problems among them, 39.2% had Gastroenteritis, 28.3% had appendicitis, 5.8% intestinal obstruction, 4.2% appendicular mass, 1.7% perforated appendix with the same percentage for intussusception, 23.0% suffered from mesenteric lymphadenitis, 7.0% had genitourinary symptoms and 6.0% were presented with non-specific symptoms. There was a highly significant association between the management plan and the surgical outcome of the cases, where the ultrasound was diagnostic among the majority (95.3%) of the operated patients.

Conclusions: Ultrasound helped in earlier diagnoses of acute abdominal conditions and reduced radiation exposure to the pediatric age group.

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References

Banerjee R, Prasad A, Gupta S. Clinical spectrum of acute abdomen in children admitted to pediatric emergency department: A prospective study, Curr Med Res Prac. 2019, 9: 2: 49-52. Available from: https://www.sciencedirect.com/science/article/abs/pii/S2352081718301788.

Jangra B, Jangra MS, Rattan KN, et al. Seasonal and day of week variations in acute appendicitis in north Indian children. J Indian Assoc Pediatr Surg. 2013, 18: 1: 42-3. Available from: - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3628249/.

Tseng YC, Lee MS, Chang YJ. et al. Acute abdomen in pediatric patients admitted to the pediatric emergency department. Pediatr Neonatol. 2008, 49:4:126-34. Available from: - https://pubmed.ncbi.nlm.nih.gov/19054918/.

Snyder MJ, Guthrie M, Cagle S. Acute Appendicitis: Efficient Diagnosis and Management. Am Fam Physician. 2018, 98:1:25-33. Available from: https://pubmed.ncbi.nlm.nih.gov/30215950/.

Burrowes D, Choi H, Rodgers S, Fetzer D, Kamaya A. Utility of ultrasound in acute pancreatitis. Abdom Radiol; 45, 1253–64 (2020). Available from: - https://doi.org/10.1007/s00261-019-02364-x.

Fonio P, Coppolino F, Russo A. et al. Ultrasonography (US) in the assessment of pediatric non-traumatic gastrointestinal emergencies. Crit Ultrasound J. 2013, 5:1: 12. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3711736/.

Telesmanich ME, Orth RC, Zhang W. et al. Searching for certainty: findings predictive of appendicitis in equivocal ultrasound exams. Pediatr Radiol. 2016, 46:11:1539-45. Available from: https://link.springer.com/article/10.1007/s00247-016-3645-4#citeas.

Linam LE, Munden M. Sonography as the first line of evaluation in children with suspected acute appendicitis. J Ultrasound Med. 2012, 31:8:1153-7. Available from: - https://pubmed.ncbi.nlm.nih.gov/22837278/.

Acimi S. Acute ovarian torsion in young girls, Journal of Acute Disease. 2016, 5:1: 59-61. Available from: - https://www.sciencedirect.com/science/article/pii/S2221618915000876.

BakerR D. “Acute Abdominal Pain.” Pediatrics in Review. 2018, 39:3:130 - 139. Available from: https://www.publications.aap.org/pediatricsinreview/article-abstract/39/3/130/35119/Acute-Abdominal-Pain.

Kahn MG, Bailey LC, Forrest CB. et al. Building a common pediatric research terminology for accelerating child health research. Pediatrics. 2014, 133:3:516-25. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3934328/.

Bundy DG, Byerley JS, Liles EA. et al. Does this child have appendicitis? JAMA. 2007, 298: 4 :438-51. Available from: - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2703737/.

AIUM practice guideline for the performance of an ultrasound examination of the abdomen and/or retroperitoneum. J Ultrasound Med. 201, 31:8:1301-12. Available from: - https://pubmed.ncbi.nlm.nih.gov/22837300/.

Russo A, Cappabianca S, Iaselli F. et al. Acute abdominal pain in childhood and adolescence: assessing the impact of sonography on diagnosis and treatment. J Ultrasound. 2013,16:4:201-7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3846956/.

Hampson F, Shaw AS. Assessment of the acute abdomen: role of the plain abdominal radiograph. Reports in Medical Imaging. 2010, 3:93-105. Available from: https://doi.org/10.2147/RMI.S13837.

Pedram A, Asadian F, Roshan N. Diagnostic Accuracy of Abdominal Ultrasonography in Pediatric Acute Appendicitis. Bull Emerg Trauma. 2019, 7:3:278-283. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681883/.

Hwang H, Marsh I, Doyle J. Does ultrasonography accurately diagnose acute cholecystitis? Improving diagnostic accuracy based on a review at a regional hospital. Can J Surg. 2014, 57:3:162-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4035397/.

Bolli P, Schädelin S, Holland-Cunz S. et al. Ovarian torsion in children: Development of a predictive score. Med (Baltimore). 2017, 96: 43: e8299. Available from:- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5671833/#.

Rey-Bellet GC, Gehri M, Joseph JM. et al. Is It Ovarian Torsion? A Systematic Literature Review and Evaluation of Prediction Signs. Pedia Emerg Care. 2016, 32:4:256-61. Available from: https://pubmed.ncbi.nlm.nih.gov/26855342/.

Khalid M, Redhu N, Nazir B. et al. Diagnostic value of ultrasonography in evaluation and management of acute abdominal conditions in the paediatric age group. Afr J Paediatr Surg. 2012, 9: 3: 198-201. Available from: - https://www.afrjpaedsurg.org/text.asp?2012/9/3/198/104719.

Scammell S, Lansdale N, Sprigg A. et al. Ultrasonography aids decision-making in children with abdominal pain. Ann R Coll Surg Engl. 2011, 93:5:405-9. Available from: - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3365462/ 32.

Boonstra PA, van Veen RN, Stockmann HB. Less negative appendectomies due to imaging in patients with suspected appendicitis. Surg Endosc. 2015, 29:8:2365–70. Available from: - https://pubmed.ncbi.nlm.nih.gov/25475515/.

Lahaye MJ, Lambregts DM, Mutsaers E. et al. Mandatory imaging cuts costs and reduces the rate of unnecessary surgeries in the diagnostic work-up of patients suspected of having appendicitis. Eur Radiol . 2015,25:5:1464–70. Available from: - https://pubmed.ncbi.nlm.nih.gov/29540260/.

Abdel-Gawad M, Kadasne RD, Elsobky E. et al. A Prospective Comparative Study of Color Doppler Ultrasound with Twinkling and Noncontrast Computerized Tomography for the Evaluation of Acute Renal Colic. J Urol. 2016,196:3:757-62. Available from: - https://pubmed.ncbi.nlm.nih.gov/27063853/.

Chiorean L, Schreiber-Dietrich D, Braden B. et al. Ultrasonographic imaging of inflammatory bowel disease in pediatric patients. World J Gastroenterol. 2015, 7:21:17:5231-41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4419063/.

Esposito F, Di Serafino M, Mercogliano C. et al. The pediatric gastrointestinal tract: ultrasound findings in acute diseases. J Ultrasound. 2019, 22:4:409-422. Available from: -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6838286/.

Biko DM, Rosenbaum DG, Anupindi SA. Ultrasound features of paediatric Crohn disease: a guide for case interpretation. Pediatr Radiol. 2015, 45:10:15571566. Available from: https://www.researchgate.net/publication/331076506_The_pediatric_gastrointestinal_tract_ultrasound_findings_in_acute_diseases.

Hijaz NM, Friesen CA. Managing acute abdominal pain in pediatric patients: current perspectives. Pediatric Health Med Ther. 2017, 8:83-91. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774593/.

Ghani R, O'Connor A, Sajid I. et al. Diagnostic accuracy of ultrasound in the paediatric population with acute right iliac fossa pain, our District General Hospital experience. Ulster Med J. 2022, 91:1:26-29. Available from:- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8835414/.

Elsherbini R, Alkhatrawi T. Appendicular Mass in Children: Our Experience with Early Appendectomy. Med. J. Cairo Univ. 2020, 88:5: 2255-2260. Available from: -https://mjcu.journals.ekb.eg/article_125314_675ae0af02621bae2e54d9284c7de9ff.pdf.