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Outcome After Exploratory Laparoscopy for Unexplained Abdominal Pain in Childhood

Outcome After Exploratory Laparoscopy for Unexplained Abdominal Pain in Childhood Abstract Background: Abdominal pain in childhood is common yet frustrating when unexplained. Objective: To describe the clinical features and outcome of 8 children (6 girls and 2 boys; mean[±SD] age, 13±2 years) with unexplained abdominal pain who underwent exploratory laparoscopy. Setting: All 8 patients were examined at an academic pediatric gastroenterology center and referred for exploratory laparoscopy because of unexplained abdominal pain. Laparoscopy was offered after family agreement to pursue behavioral management if the pain and disability did not improve. Results: In all 8 children, laparoscopy detected an anomaly at a site corresponding to that of the abdominal pain. Findings were adhesions in 7 children (3 colonic, 2 ileocecal, 1 gastric, and 1 appendiceal) and ovarian torsion in 1 child. At a mean follow-up of 12.6 months, the abdominal pain had completely resolved in 6 children, notably improved in 1 child, and continued unchanged in 1 child. Disability completely resolved in 2 of 3 children. Conclusions: In children with unexplained abdominal pain that is acute in onset, well described, and suggestive of peritoneal involvement, exploratory laparoscopy (1) successfully ends the cycle of abdominal pain in most cases; and (2) commonly identifies abnormalities, usually adhesions. However, whether laparoscopy, the placebo effect, or both promote the healing process is unclear. Further study is needed to develop criteria for referral for laparoscopic evaluation of unexplained abdominal pain.Arch Pediatr Adolesc Med. 1997;151:993-998 References 1. Hyams J, Burke G, Davis P, Rzepski B, Andrulonis P. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study . J Pediatr . 1996; 129:220-226.Crossref 2. Boyle J. Abdominal pain . In: Walker W, Hamilton J, Walker-Smith J, Watkins J, eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Manage ment . St Louis, Mo: Mosby–Year Book Inc; 1996;1:205-226. 3. Apley J. The child with recurrent abdominal pain . Pediatr Clin North Am . 1967; 14:63-72. 4. Murphy MS. Management of recurrent abdominal pain . Arch Dis Child . 1993; 69:409-411.Crossref 5. Wyllie R, Kay M. Causes of recurrent abdominal pain . Clin Pediatr (Phila) . 1993; 32:369-371.Crossref 6. Lindberg T. Recurrent abdominal pain in childhood . Acta Paediatr . 1994;83:775-776.Crossref 7. Walker L, Garber J, Slyke DV, Greene J. Long-term health outcomes in patients with recurrent abdominal pain . J Pediatr Psychol . 1995;20:233-245.Crossref 8. Masek BJ, Russo DC, Varni JW. Behavioral approaches to the management of chronic pain in children . Pediatr Clin North Am . 1984;31:1113-1131. 9. Apley J. Psychosomatic aspects of gastrointestinal problems in children . Clin Gastroenterol . 1977;6:311-320. 10. Schrenk P, Woisetschlager R, Wayand W, Rieger R, Sulzbacher H. Diagnostic laparoscopy: a survey of 92 patients . Am J Surg . 1994;168:348-351.Crossref 11. Stylianos S. Stein J, Flanigan L, Hechtman D. Laparoscopy for diagnosis and treatment of recurrent abdominal pain in children . J Pediatr Surg . 1996;31:1158-1160.Crossref 12. Nagy A, James D. Diagnostic laparascopy . Am J Surg . 1989;157:490-493.Crossref 13. Nielsen O, Christiansen J. Chronic abdominal pain and Meckel's diverticulum . Acta Chir Scand . 1972;139:739-741. 14. Mattei P, Sola J, Yeo C. Chronic and recurrent appendicitis are uncommon entities often misdiagnosed . JAm Coll Surg . 1994;178:385-389. 15. Akgur F, Tanyel F, Buyukpamukcu N, Hicsonmez A. Anomalous congenital bands causing intestinal obstruction in children . J Pediatr Surg . 1992;27:471-473.Crossref 16. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1000 school children . Arch Dis Child . 1958;33:165-170.Crossref 17. Adams J. Weaver S. Self-esteem and perceived stress in young adolescents with chronic disease . J Adolesc Heath Care . 1986;7:173-177.Crossref 18. Hodges K, Kline J, Barbero G, Flanery R. Depressive symptoms in children with recurrent abdominal pain and in their families . J Pediatr . 1985;107:622-626.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Outcome After Exploratory Laparoscopy for Unexplained Abdominal Pain in Childhood

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References (20)

Publisher
American Medical Association
Copyright
Copyright © 1997 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1997.02170470027006
Publisher site
See Article on Publisher Site

Abstract

Abstract Background: Abdominal pain in childhood is common yet frustrating when unexplained. Objective: To describe the clinical features and outcome of 8 children (6 girls and 2 boys; mean[±SD] age, 13±2 years) with unexplained abdominal pain who underwent exploratory laparoscopy. Setting: All 8 patients were examined at an academic pediatric gastroenterology center and referred for exploratory laparoscopy because of unexplained abdominal pain. Laparoscopy was offered after family agreement to pursue behavioral management if the pain and disability did not improve. Results: In all 8 children, laparoscopy detected an anomaly at a site corresponding to that of the abdominal pain. Findings were adhesions in 7 children (3 colonic, 2 ileocecal, 1 gastric, and 1 appendiceal) and ovarian torsion in 1 child. At a mean follow-up of 12.6 months, the abdominal pain had completely resolved in 6 children, notably improved in 1 child, and continued unchanged in 1 child. Disability completely resolved in 2 of 3 children. Conclusions: In children with unexplained abdominal pain that is acute in onset, well described, and suggestive of peritoneal involvement, exploratory laparoscopy (1) successfully ends the cycle of abdominal pain in most cases; and (2) commonly identifies abnormalities, usually adhesions. However, whether laparoscopy, the placebo effect, or both promote the healing process is unclear. Further study is needed to develop criteria for referral for laparoscopic evaluation of unexplained abdominal pain.Arch Pediatr Adolesc Med. 1997;151:993-998 References 1. Hyams J, Burke G, Davis P, Rzepski B, Andrulonis P. Abdominal pain and irritable bowel syndrome in adolescents: a community-based study . J Pediatr . 1996; 129:220-226.Crossref 2. Boyle J. Abdominal pain . In: Walker W, Hamilton J, Walker-Smith J, Watkins J, eds. Pediatric Gastrointestinal Disease: Pathophysiology, Diagnosis, Manage ment . St Louis, Mo: Mosby–Year Book Inc; 1996;1:205-226. 3. Apley J. The child with recurrent abdominal pain . Pediatr Clin North Am . 1967; 14:63-72. 4. Murphy MS. Management of recurrent abdominal pain . Arch Dis Child . 1993; 69:409-411.Crossref 5. Wyllie R, Kay M. Causes of recurrent abdominal pain . Clin Pediatr (Phila) . 1993; 32:369-371.Crossref 6. Lindberg T. Recurrent abdominal pain in childhood . Acta Paediatr . 1994;83:775-776.Crossref 7. Walker L, Garber J, Slyke DV, Greene J. Long-term health outcomes in patients with recurrent abdominal pain . J Pediatr Psychol . 1995;20:233-245.Crossref 8. Masek BJ, Russo DC, Varni JW. Behavioral approaches to the management of chronic pain in children . Pediatr Clin North Am . 1984;31:1113-1131. 9. Apley J. Psychosomatic aspects of gastrointestinal problems in children . Clin Gastroenterol . 1977;6:311-320. 10. Schrenk P, Woisetschlager R, Wayand W, Rieger R, Sulzbacher H. Diagnostic laparoscopy: a survey of 92 patients . Am J Surg . 1994;168:348-351.Crossref 11. Stylianos S. Stein J, Flanigan L, Hechtman D. Laparoscopy for diagnosis and treatment of recurrent abdominal pain in children . J Pediatr Surg . 1996;31:1158-1160.Crossref 12. Nagy A, James D. Diagnostic laparascopy . Am J Surg . 1989;157:490-493.Crossref 13. Nielsen O, Christiansen J. Chronic abdominal pain and Meckel's diverticulum . Acta Chir Scand . 1972;139:739-741. 14. Mattei P, Sola J, Yeo C. Chronic and recurrent appendicitis are uncommon entities often misdiagnosed . JAm Coll Surg . 1994;178:385-389. 15. Akgur F, Tanyel F, Buyukpamukcu N, Hicsonmez A. Anomalous congenital bands causing intestinal obstruction in children . J Pediatr Surg . 1992;27:471-473.Crossref 16. Apley J, Naish N. Recurrent abdominal pains: a field survey of 1000 school children . Arch Dis Child . 1958;33:165-170.Crossref 17. Adams J. Weaver S. Self-esteem and perceived stress in young adolescents with chronic disease . J Adolesc Heath Care . 1986;7:173-177.Crossref 18. Hodges K, Kline J, Barbero G, Flanery R. Depressive symptoms in children with recurrent abdominal pain and in their families . J Pediatr . 1985;107:622-626.Crossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Oct 1, 1997

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