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An unusual case of pediatric abdominal pain

Published online by Cambridge University Press:  11 May 2015

Lars P. Bjoernsen  and
M. Bruce Lindsay
Lars P. Bjoernsen
Affiliation:
Section of Emergency Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
M. Bruce Lindsay*
Affiliation:
Section of Emergency Medicine, University of Wisconsin Hospital and Clinics, Madison, WI
*
Section of Emergency Medicine, University of Wisconsin Hospital and Clinics, F2/210 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792-3284; mbl@medicine.wisc.edu

Abstract

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Chronic and recurrent abdominal pains are common complaints in children and adolescents, but the evaluation in the emergency department (ED) can be challenging. We present a rare yet serious case of a 17-year-old white female who presented to the ED with a 2-day history of diffuse abdominal pain, nausea, and intractable vomiting. Abdominal examination and imaging, including computed tomography (CT), were negative during an episode 6 weeks previously. This was her fifth similar episode in a 2-month period, and she had been seen at three different hospitals and admitted on each occasion. Three days prior to presentation to our ED, she was seen at a gastroenterology clinic and diagnosed with irritable bowel syndrome and an ovarian cyst. Symptomatic therapy during the current presentation, with intravenous fluids, antiemetics, and parenteral narcotics, failed to alleviate her abdominal pain and vomiting. Emergent CT evaluation revealed a high-grade colonic obstruction with focal circumferential narrowing in the transverse colon and a lower gastrointestinal follow-through radiograph with Gastrografin enema showed a classic “apple-core” lesion. Colonic adenocarcinoma with positive regional lymph nodes was found during emergent exploratory laparotomy. Pediatric patients with recurrent, episodic abdominal pain should undergo systematic evaluation and symptomatic treatment. A previous negative workup should not dissuade emergency physicians from proceeding with a systematic and thorough evaluation of the pediatric patient presenting with abdominal pain and vomiting.

Keywords

abdominal painadenocarcinomaadolescencecolorectalpathology
Type
Case Report • Rapport de cas
Information
Canadian Journal of Emergency Medicine , Volume 13 , Issue 2 , March 2011 , pp. 133 - 138
Copyright
Copyright © Canadian Association of Emergency Physicians 2011

References

REFERENCES

1.Hyams, JS, Burke, G, Davis, PM, et al. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study. J Pediatr 1996;129:220–6.Google Scholar
2.Reynolds, SL, Jaffe, DM. Diagnosing abdominal pain in a pediatric emergency department. Pediatr Emerg Care 1992;8:126–8.CrossRefGoogle Scholar
3.Noe, JD, Li, BUK. Navigating recurrent abdominal pain through clinical clues, red flags, and initial testing. Pediatr Ann 2009;35:259–66.Google Scholar
4.Chitkara, DK, Rawat, DJ, Talley, NJ. The epidemiology of childhood recurrent abdominal pain in Western countries: a systematic review. Am J Gastroenterol 2005;100:1868–75.Google Scholar
5.Ramchandani, PG, Hotopf, M, Sandhu, B, et al. The epidemiology of recurrent abdominal pain from 2 to 6 years of age: results of a large, population-based study. Pediatrics 2005;116:46–50.Google Scholar
6.Alfven, G. One hundred cases of recurrent abdominal pain in children: diagnostic procedures and criteria for a psychosomatic diagnosis. Acta Paediatr 2003;92:43–9.CrossRefGoogle ScholarPubMed
7.Hyams, JS, Hyman, PE. Recurrent abdominal pain and the biopsychosocial model of medical practice. J Pediatr 1998;133:473–8.Google Scholar
8.Drossman, D, Thompson, W, Talley, N, et al. Identification of subgroups of functional bowel disorders. Gastroenterol Int 1990;3:159–72.Google Scholar
9.Lake, AM. Chronic abdominal pain in childhood: diagnosis and management. Am Fam Physician 1999;59:1823–30.Google Scholar
10.Dern, MS, Stein, MT. “He keeps getting stomachaches, Doctor. What’s wrong?” Contemp Pediatr 1999;16:43.Google Scholar
11.Frank, F, Stricker, T, Stallmach, T, et al. Helicobacter pylori infection in recurrent abdominal pain. J Pediatr Gastroenterol Nutr 2000;31:424–7.Google Scholar
12.Hyams, JS. Chronic abdominal pain caused by sorbitol malabsorption. J Pediatr 1982;100:772–3.CrossRefGoogle ScholarPubMed
13.Liebman, WM. Recurrent abdominal pain in children: a retrospective survey of 119 patients. Clin Pediatr (Phila) 1978;17:149–53.Google Scholar
14.Mason, JD. The evaluation of acute abdominal pain in children. Emerg Med Clin North Am 1996;14:629–43.CrossRefGoogle ScholarPubMed
15.Fraser, GC. Children with acute abdominal pain. Taking a reasonable approach. Can Fam Physician 1993;39:1461–2.Google Scholar
16.Andersson, A, Bergdahl, L. Carcinoma of the colon in children: a report of six new cases and a review of the literature. J Pediatr Surg 1976;11:967–71.CrossRefGoogle Scholar
17.Bethel, CA, Bhattacharyya, N, Hutchinson, C, et al. Alimentary tract malignancies in children. J Pediatr Surg 1997;32:1004–8; discussion 8-9.Google Scholar
18.Ladd, AP, Grosfeld, JL. Gastrointestinal tumors in children and adolescents. Semin Pediatr Surg 2006;15:37–47.CrossRefGoogle ScholarPubMed
19.Pickett, LK, Briggs, HC. Cancer of the gastrointestinal tract in childhood. Pediatr Clin North Am 1967;14:223–34.Google Scholar
20.Pratt, CB, Rivera, G, Shanks, E, et al. Colorectal carcinoma in adolescents: implications regarding etiology. Cancer 1977;40:2464–72.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
21.Rao, BN, Pratt, CB, Fleming, ID, et al. Colon carcinoma in children and adolescents. A review of 30 cases. Cancer 1985;55:1322–6.Google Scholar
22.Yang, R, Cheung, MC, Zhuge, Y, et al. Primary solid tumors of the colon and rectum in the pediatric patient: a review of 270 cases. J Surg Res 2010;161:209–16.Google Scholar
23.Cain, AS, Longino, LA. Carcinoma of the colon in children. J Pediatr Surg 1970;5:527–32.Google Scholar
24.Gold-Thorn, JF, Powars, D, Hays, DM. Adenocarcinoma of colon and rectum in the adolescent. Surgery 1983;93:409–14.Google Scholar
25.Middelkamp, JN, Haffner, H. Carcinoma of the colon in children. Pediatrics 1963;32:558–71.Google Scholar
26.O’Neill, JA Jr.Colorectal tumors. In: Benson’s text book of paediatric surgery. 4th ed. Chicago, London: Year Book Medical Publisher; 1986. p. 1020–1.Google Scholar
27.Minardi, AJ Jr, Sittig, KM, Zibari, GB, et al. Colorectal cancer in the young patient. Am Surg 1998;64:849–53.Google ScholarPubMed
28.Kwok, MY, Kim, MK, Gorelick, MH. Evidence-based approach to the diagnosis of appendicitis in children. Pediatr Emerg Care 2004;20:690–8; quiz 699-701.CrossRefGoogle Scholar
29.Saps, M, Sztainberg, M, Di Lorenzo, C. A prospective community-based study of gastroenterological symptoms in school-age children. J Pediatr Gastroenterol Nutr 2006;43:477–82.CrossRefGoogle ScholarPubMed
30.Fewis, CTP, Riley, K, Georgeson, HK. Carcinoma of the colon and rectum in patients less than 20 years of age. South Afr Med 1990;83:383–5.Google Scholar
31.Shah, RS, Pikale, HS, Birmole, BJ, et al. Adenocarcinoma of the colon in a child. J PostgradMed 1992;38:81–3.Google Scholar
32.Chabalke, JB, Firaumeni, JF. Colorectal cancer in children: epidemiological aspects. Dis Colon Rectum 1975;18:1–12.CrossRefGoogle Scholar
33.Karnak, I, Ciftci, AO, Senocak, ME, et al. Colorectal carcinoma in children. J Pediatr Surg 1999;34:1499–504.Google Scholar
34.Taguchi, T, Suita, S, Hirata, Y, et al. Carcinoma of the colon in children: a case report and review of 41 Japanese cases. J Pediatr Gastroenterol Nutr 1991;12:394–9.Google Scholar
35.Williams, C Jr.Carcinoma of the colon in childhood. Ann Surg 1954;139:816–22; discussion 22-5.CrossRefGoogle ScholarPubMed
36.Johnson, JW, Judd, ES, Dahlin, DC. Malignant neoplasms of the colon and rectum in young persons. Arch Surg 1959;79:365–72.CrossRefGoogle ScholarPubMed