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Pediatric Small Talk – The Rule of 6: Pediatric Abdominal Surgical Emergencies

Similar to the adult population, the differential diagnosis for a child with abdominal pain is broad... One way to help remember the general ages of presentation for common pediatric abdominal surgical emergencies is the mnemonic known as “the rule of 6.” While not everyone follows the rule, common ages of presentation include: malrotation with midgut volvulus at around 6 days of life, pyloric stenosis at around 6 weeks of life, intussusception at around 6 months of life, and appendicitis at around 6 years of life.

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 When Sick Means Sick: Emesemantics and Vomiting in Kids

In newborns and infants, bilious vomiting represents intestinal obstruction and is a surgical emergency. There are a variety of causes – duodenal atresia, midgut malrotation and volvulus, jejunoileal atresia, meconium ileus (which has its own subset of causes) and necrotising enterocolitis are a few. Most ED clinicians don’t need to know much detail about this other than that green vomitus in a neonate – with or without abdominal distension – warrants a paediatric (or neonatal) surgical review urgently. These babies are very sick (unwell) and may need access (IV or IO) with fluid replacement and NG placement (free drainage to reduce further vomiting).

Articles of Interest

Episode 10 – Pediatric GI Emergencies

Bilious vomiting, medical speaking, means emesis that appears like cooked, green spinach – not the yellow color that parents often mean. While sometimes normal in older children with gastroenteritis, in neonates or anyone sick appearing, this represents a surgical emergency such as volvulus, malrotation, necrotizing enterocolitis etc.

Neonatal Intestinal Emergencies

A surgical abdomen in the neonate is a rare event, but is associated with high morbidity and mortality. Intestinal obstruction can quickly lead to severe dehydration, electrolyte abnormalities, sepsis and irreversible intestinal ischemia. Early recognition and intervention are crucial to maintain intestinal perfusion and prevent the serious sequelae of short gut syndrome.

Paediatric GI emergencies

Paediatric GI emergencies constitute a wide range of gut pathologies ranging from those that are common, easily diagnosed and treated to conditions that are rarer, often more severe and challenging to manage. Among a myriad of ordinary clinical symptoms and signs physicians have to identify the child with a serious, life-threatening pathology and initiate the appropriate diagnostic and therapeutic pathway.

Pediatric Gastroenteritis, Constipation and Bowel Obstruction

In Part 2 of this pediatric abdominal pain Episode – Pediatric Gastroenteritis, Constipation & Bowel Obstruction, Dr. Anna Jarvis, Canada’s “mother of pediatric emergency medicine” and Dr. Stephen Freedman, one of Canada’s pre-eminent researchers in pediatric GI emergencies, discuss the assessment, work-up and treatment of pediatric gastroenteritis, with particular attention to gastroenteritis & acute abdomen mimics, how best to assess hydration status, the nuances of the use of ondansetron and the prose and cons of various rehydration methods.

Ultrasound of the Pediatric Gastrointestinal Emergencies

With recent technologies, ultrasound has become an extremely useful imaging modality for evaluating children with acute abdominal symptoms. Higher frequency transducers can be used in children than in adults, owing to their small body size, the presence of less fat tissue in the abdominal wall and peritoneal cavity leading to higher resolution than computed tomography in many circumstances without exposure to ionizing radiation.

Resources

Applied Radiology

Gastrointestinal (GI) complaints are among the most frequent causes for emergency department visits in the pediatric population. Radiology plays an ever-increasing role in the diagnosis and treatment of these emergencies. This article describes the clinical presentation, epidemiology, and imaging findings of 5 GI emergencies that require surgical intervention: Malrotation and midgut volvulus; intussusception; hypertrophic pyloric stenosis; appendicitis; and Meckel's diverticulum.