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Acute Abdominal Pain
Albert Ross and Neal S. LeLeiko
Pediatrics in Review 2010;31;135
DOI: 10.1542/pir.31-4-135

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Article

gastrointestinal

Acute Abdominal Pain
Albert Ross, MD,*
Neal S. LeLeiko, MD, PhD*

Author Disclosure
Drs Ross and LeLeiko
have disclosed no
financial relationships

Objectives

After completing this article, readers should be able to:

1. Understand the principal causes of acute abdominal pain in children.
2. Describe the characteristics ofvisceral versus somatic abdominal pain.
3. Be familiar with the differential diagnosis of abdominal pain based on symptoms and
location of pain.
4. Discuss the evaluation of acute abdominal pain.
5. Distinguish surgical from medical abdominal pain.

relevant to this
article. This
commentary does not
contain a discussion
of an unapproved/
investigative use of a
commercial product/
device.The Problem
“Hello, Doctor Jones, Billy has an awful tummy ache!” For such a simple statement, so many
possible outcomes exist. Is this an emergency? Does he have appendicitis? Does he need a
surgeon? Is this something trivial? Has Billy eaten something harmful? Is he constipated?
Acute abdominal pain can be caused by myriad conditions whose outcomes vary from rapid
improvement to surgery,posing a diagnostic Gordian Knot. However, through evaluation
of the patient’s history and symptoms and the use of technology, a pediatrician usually can
arrive at a reasonable conclusion about the care of the patient, even if the diagnosis still is
undetermined.
Acute abdominal pain can be classified according to its location and nature, history, or
associated signs (Table 1).

Location andNature
Some conditions can cause pain in different regions, and it may be difficult to associate the
disease with the location of the pain. Localization of the source of abdominal pain is
confounded by the nature of the pain receptors involved. Further, the type of pain
associated with a particular disease may change as the disease process progresses, as in
appendicitis. Abdominal pain may beclassified as visceral, somatoparietal, and referred
pain. Most abdominal pain is associated with visceral pain receptors.
Visceral pain receptors are located in the muscles and mucosa of hollow organs, in the
mesentery, and on serosal surfaces. These pain receptors typically respond to stretch, such
as when the bowel is distended or mesentery is stretched or torsed. Visceral pain response
isnot well localized because the afferent nerves associated with this pain have fewer nerve
endings in the gut, are not myelinated, are bilateral, and enter the spinal cord at several
levels. However, there are three broad areas of association. Visceral pain in the stomach,
lower esophagus, and duodenum is perceived in the epigastric area. Pain emanating from
the small intestine is felt in theumbilical area. Colonic visceral pain is felt in the lower
abdomen. The pain can be described as dull, diffuse, cramping, or burning and may
prompt the child to move in an attempt to decrease the pain. Because autonomic nerves
may be involved secondarily in the same pathologic process, patients also may exhibit
sweating, nausea, vomiting, pallor, and anxiety.
Somatoparietal pain receptors...