Different localizations of the pain in the child
Upper abdominal pain in children is often difficult to diagnose, as the location of the pain is often not precisely indicated. In the upper abdomen, hypertrophic pyloric stenosis with pain is particularly common. This is an increase in muscle size of the stomach outlet.
The actual growth of this muscle layer only takes place after birth, so that most newborns become conspicuous at the age of 4 to 8 weeks. Due to the hypertrophic muscles, the stomach contents can no longer be transported further into the intestines. Due to the strong stomach filling, newborns suffer from severe abdominal pain and vomiting immediately after eating in a torrent.
In addition, a slow weight loss is often noticeable. Due to these strong symptoms, the children are operated on immediately after diagnosis. This is a small operation with longitudinal splitting of the affected muscles (according to Weber- Ramstedt).
If the therapy is successful, the prognosis is excellent. The children can be fed normally after the operation and thrive well. Invagination can also lead to severe abdominal pain.
This is an invagination of two parts of the intestine into each other, so that the intestinal contents cannot be transported further. This leads to severe pain, alternating with phases of complete exhaustion and lethargy. Mostly children between the 3rd month of life and the 2nd year of life are affected.
The symptoms begin suddenly and can cause bloody stools. The primary therapy consists of the attempt of hydrostatic reduction. The intestine is repositioned by filling it with contrast medium.
If this is not successful, in some cases surgery is necessary to manually reposition the bowel. If the therapy is performed early, the prognosis is good. However, the disease may reoccur.
Some examination methods such as colonoscopy can also cause pain in the upper abdomen. Inguinal hernias are a common disease, especially in premature babies. Often an insufficient closure of the inguinal canal is responsible for the inguinal hernia.
If no part of the intestine is trapped in the hernial sac, no pain occurs. An incarcerated inguinal hernia is accompanied by severe, sudden pain in the inguinal region. In addition, the hernia is often palpable in the hernial sac in the region of the groin.
Inflammatory signs such as fever are absent in many cases. Since the inguinal hernia leads to an incarceration of the intestine, it must also be treated as soon as possible. In some cases the hernia can be reduced manually.
Subsequently, the surgical closure of the inguinal hernia should be performed promptly. If the hernia cannot be released from the incarceration, surgery must be performed immediately to prevent the affected part of the intestine from dying off. A torsion of the testis can also lead to sudden severe pain as this is a twisting of the spermatic cord with the supplying vessels and nerves.
Often boys are affected by testicular torsion during puberty. In most cases the testicular torsion can also be treated manually. If this does not succeed, the scrotum must be surgically opened and the spermatic cord manually reduced.
Likewise, if ureteral stones are too large to pass through the ureter, they can cause colicky pain in the lower abdomen. In children, underlying diseases requiring therapy may be the cause, so that kidney disease or metabolic disorders should be excluded in the case of ureteral stones. In most cases, a pain-relieving and antispasmodic therapy is sufficient and the stone is transported into the bladder by itself and then excreted.
If this is not the case, the stone must be dissolved by stone-dissolving medication. In exceptional cases, surgical removal of the stone is necessary. An ultrasound-guided shock wave therapy is generally not used in children.
Just as on the left side, torsion of the testicles, inguinal hernia or ureteral stones can cause pain on the right side. In the right lower abdomen there is also the appendix, which can become inflamed and cause appendicitis. This inflammation is usually accompanied by appendicitis:
- Slight fever
- Nausea
- Vomiting and
- Constipation or diarrhoea
