Pediatric emergency medicine trisk 1046 1046
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consider those self-limiting or nonspecific causes of abdominal pain. The
algorithm presented in this chapter for the approach to abdominal pain is shown
in Figure 53.1 .
Abdominal Pain in the Setting of Trauma
In the setting of major trauma, the physician should perform a rapid physical
examination to distinguish superficial injury (e.g., soft tissue or muscle
contusion) from significant intra-abdominal trauma (e.g., splenic hematoma or
rupture, liver injury, or hollow viscus perforation) (see Chapter 103 Abdominal
Trauma ).
Children with localized and/or acute pain after blunt trauma may appear
surprisingly well yet have significant solid organ or hollow viscus trauma. When
significant intra-abdominal injury is suspected in a stable patient, an urgent
computed tomography (CT) scan should be obtained to evaluate for solid organ
injury. Lacerations of the liver and spleen are the most common intra-abdominal
injuries seen in children. Bedside ultrasound (f ocused a ssessment with s
onography in t rauma [FAST]) may be used to evaluate for hemoperitoneum. The
sensitivity of ultrasound for the detection of solid organ injury is low, and some
children with liver and splenic lacerations have minimal intra-abdominal fluid.
Given the low sensitivity of the FAST exam for detecting solid organ injury and
hemoperitoneum, it should not be used as the sole diagnostic test to exclude intraabdominal injury in children.
