From the Guidelines
Periumbilical pain in pediatric patients is a significant symptom that warrants immediate medical evaluation, as it can be an early indicator of acute appendicitis, among other serious conditions. When considering the potential causes of periumbilical pain in children, it is essential to recognize that the differential diagnosis is broad, including infectious, inflammatory, musculoskeletal, traumatic, gynecologic, and other etiologies 1. However, acute appendicitis is a critical consideration due to its potential need for surgical intervention. According to the American College of Radiology, approximately 70,000 children per year in the United States are diagnosed with acute appendicitis, which accounts for close to 30% of the total cost of all pediatric general surgical conditions combined 1.
Some key points to consider when evaluating periumbilical pain in pediatric patients include:
- The classic presenting symptoms of periumbilical pain, anorexia, nausea, vomiting, guarding, and migration of pain to the right lower quadrant (RLQ) are not always elicited and are only moderately reproducible between clinicians 1.
- These symptoms are less reliable in the pediatric population, particularly those <5 years of age, who more frequently present with atypical symptoms 1.
- Perforated appendicitis tends to be more common in children than adults, and while morbidity is similar to or lower in children than in adults, prompt diagnosis and treatment are crucial to prevent complications 1.
- Imaging plays a role in identifying candidates for nonoperative management and has been shown to facilitate management and decrease the rate of negative appendectomies in children with suspected acute appendicitis 1.
Given the potential severity of conditions associated with periumbilical pain in pediatric patients, parents should seek medical evaluation if periumbilical pain persists beyond a few hours, especially if accompanied by fever, persistent vomiting, or signs of dehydration. A thorough medical evaluation, including physical examination and potentially imaging studies, is necessary to determine the underlying cause of periumbilical pain and provide appropriate treatment.
From the Research
Periumbilical Pain in Pediatric Patients
Periumbilical pain in pediatric patients refers to pain located around the belly button. The causes of this type of pain can vary depending on the age of the child.
- In infants and toddlers, clinicians should consider congenital anomalies and other causes, including malrotation, hernias, Meckel diverticulum, or intussusception 2.
- In school-aged children, constipation and infectious causes of pain, such as gastroenteritis, colitis, respiratory infections, and urinary tract infections, are more common 2.
- In female adolescents, clinicians should consider pelvic inflammatory disease, pregnancy, ruptured ovarian cysts, or ovarian torsion 2.
Diagnostic Approach
The diagnostic approach for periumbilical pain in pediatric patients typically involves a combination of physical examination, laboratory tests, and imaging studies.
- Initial laboratory tests may include complete blood count, erythrocyte sedimentation rate or C-reactive protein, urinalysis, and a pregnancy test 2.
- Abdominal radiography can be used to diagnose constipation or obstruction, while ultrasonography is the initial choice for diagnosing conditions such as appendicitis, cholecystitis, and ovarian cysts 2.
- A diagnostic time-out intervention can help improve the quality and documentation of differential diagnoses in pediatric patients with abdominal pain 3.
Management and Expectations
The management of periumbilical pain in pediatric patients depends on the underlying cause of the pain.