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ESSENTIAL DIAGNOSIS OF ABDOMINAL EMERGENCIES
Table 2 A brief guide to determining the diagnosis of neonatal and infant abdominal emergencies Age
Disease
Neonate Malrotation with volvulus Necrotizing enterocolitis Omphalitis Hirschsprung’s disease Infant Hypertrophic pyloric stenosis Incarcerated inguinal hernia Meckel’s diverticulum Intussusception
Appendicitis
Clinical presentation
Determining the diagnosis
Bilious vomiting
H, PE, UGI
Vomiting, abdominal distention Erythema of umbilicus Abdominal distention, diarrhea Projectile, nonbilious vomiting Inguinal mass, vomiting Rectal bleeding or bilious vomiting Vomiting, colicky abdominal pain, listless Vomiting, anorexia, fussy
H, PE, AXR
Adjunct studies
H, PE H, PE, AXR, RB
US or CT CE
H, PE, US
UGI
H, PE H, PE
MS or UGI
H, PE, A-CE
H, PE, US
CT or EL
Abbreviations: H, history; PE, physical exam; UGI, upper gastrointestinal; AXR, abdominal radiograph; US, ultrasound; RB, rectal biopsy; A–CE, air–contrast enema; MS, Meckel’s scan; EL, exploratory laparotomy.
Acknowledgements The author is indebted to Suzanne Remington, JD, and Sheryl Louie, MD, for their help in the preparation and editing of this manuscript. The author is also thankful for Loren G. Yamamoto, MD, and Dave Cox, MD, for allowing access to their radiographic libraries. The reader is invited to view more of Dr. Yamamoto’s teaching files at: www.hawaii.edu/ medicine/pediatrics. The author also appreciates Joe Arms, MD, and Amy Schirmer for their assistance.
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