To Jeanne and the other members,
I don't know if these two abstracts would be of any help. Unfortunately, I
do not at the moment have the complete articles with me.
Pete Speth, MD
J Pediatr Surg 1993 Dec;28(12):1550-2
Mesenteric lymphadenitis depicted by indium 111-labeled white blood cell
Achong DM, Oates E, Harris B
Division of Nuclear Medicine, Tufts University School of Medicine, Boston, MA.
An acutely ill child with abdominal pain and concomitant
pharyngitis often presents a diagnostic challenge. This report describes how
indium 111-labeled white blood cell imaging helped to clarify the confusing
case of a 4-year-old boy with fever, pharyngitis, and abdominal pain. The
triad of abnormal white cell localization in the nasopharynx, cervical lymph
nodes, and right lower abdominal quadrant supported the diagnosis of a
systemic infection rather than appendicitis, abscess, or another surgical
condition. Mesenteric lymphadenitis associated with systemic infection should
be included in the differential diagnosis of abdominal pain in a child with
this clinical presentation.
Pediatrics 1996 Oct;98(4 Pt 1):680-5
Clinical outcomes of children with acute abdominal pain.
Scholer SJ, Pituch K, Orr DP, Dittus RS
Department of Pediatrics, Indiana University School of Medicine,
OBJECTIVE: To determine the prevalence, associated symptoms, and
clinical outcomes of children presenting for a nonscheduled visit with acute
abdominal pain. DESIGN: Historical cohort. SETTING: Inner-city teaching
hospital. PARTICIPANTS: A total of 1141 consecutive children, ages 2 to 12,
presenting for a nonscheduled visit (clinic or emergency department) with a
complaint of nontraumatic abdominal pain of < or = 3 days' duration were
identified through a manual chart review. MEASUREMENTS: Collected data
included: 1) demographic characteristics, 2) presenting signs and symptoms,
3) records from the hospital record for all children who returned within 10
days for follow-up, 4) test results, and 5) telephone follow-up. A clinical
reviewer used the data to assign a final diagnosis to each patient. RESULTS:
The prevalence of children presenting with abdominal pain of < or = 3 days'
duration was 5.1%. The most common associated symptoms were history of fever
(64%), emesis (42.4%), decreased appetite (36.5%), cough (35.6%), headache
(29.5%), and sore throat (27.0%). The six most prevalent final diagnoses,
accounting for 84% of all final diagnoses, were upper respiratory infection
and/or otitis (18.6%), pharyngitis (16.6%), viral syndrome (16.0%), abdominal
pain of uncertain etiology (15.6%), gastroenteritis (10.9%), and acute
febrile illness (7.8%). Approximately 1% of children required surgical
intervention (10/12 for appendicitis). Approximately 7% of children returned
within 10 days for reevaluation of their illness; on return, 11 had treatable
medical diseases and 4 had diseases requiring surgical intervention.
CONCLUSIONS: An acute complaint of abdominal pain in children occurs in 5.1%
of nonscheduled visits, is frequently accompanied by multiple complaints, and
is usually attributed to a self-limited disease. Close follow-up will
identify the 1% to 2% who proceed to have a more serious disease process.
This epidemiologic data will aid clinic-based physicians who manage children
with acute abdominal pain.
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