Children Presenting at the Emergency Department With Right Lower Quadrant Pain
Right lower quadrant (RLQ) pain is a common complaint in children presenting at emergency departments. This study analyzed the etiologies of RLQ pain, and compared the clinical presentations, laboratory test results and imaging findings in patients with appendicitis with those in other groups of pat...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2009-01-01
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| Series: | Kaohsiung Journal of Medical Sciences |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1607551X09700336 |
| _version_ | 1818334144922386432 |
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| author | Chien-Heng Lin Jeon-Hor Chen Tsai-Chung Li Yung-Jen Ho Wei-Ching Lin |
| author_facet | Chien-Heng Lin Jeon-Hor Chen Tsai-Chung Li Yung-Jen Ho Wei-Ching Lin |
| author_sort | Chien-Heng Lin |
| collection | DOAJ |
| description | Right lower quadrant (RLQ) pain is a common complaint in children presenting at emergency departments. This study analyzed the etiologies of RLQ pain, and compared the clinical presentations, laboratory test results and imaging findings in patients with appendicitis with those in other groups of patients. We also investigated if active observation resulted in delayed diagnosis, to the detriment of patients. Medical records for the period January 2006 to July 2006 were reviewed for children (age < 18 years) who presented to the emergency department of one medical center, complaining of RLQ pain. Out of a total of 100 patients (age range: 2–17 years; mean: 11 years), 46 patients presented with only one symptom of RLQ pain, while 32 patients had ≥ 2 associated signs or symptoms, including fever, nausea/vomiting, diarrhea, or rebound tenderness. Imaging studies, including abdominal sonography and/or computed tomography, were performed in 73 patients; 44 underwent surgery for presumed appendicitis and one received surgery for a right paraduodenal hernia. Eleven patients underwent surgery because of peritoneal signs, and eight because of persistent or aggravated RLQ pain. Postoperative pathologic examinations revealed 53 cases of appendicitis, six normal appendices, and other morbidities (1 perforated peptic ulcer, 1 pelvic inflammatory disease, 1 ovarian cyst, 1 diverticulitis, and 1 right paraduodenal hernia). Thirty-three patients were discharged after several hours of observation (range: 0.5–18 hours; mean: 4 hours), and three patients were admitted for further observations. All were discharged without operation. There were significant differences in the incidences of fever (p = 0.004) and rebound tenderness (p = 0.019), and in white cell counts (p < 0.001), neutrophil percentages (p < 0.001), and C-reactive protein levels (p < 0.001) between patients with appendicitis and patients with other causes of RLQ pain. Clinical signs and symptoms, laboratory tests, and imaging studies can be used to differentiate between the causes of RLQ pain. Patients without the classical features of appendicitis or peritonitis can be safely managed by active observation and repeated physical examinations. |
| first_indexed | 2024-12-13T14:02:52Z |
| format | Article |
| id | doaj.art-a1d68934f9ef4504bfa2c312af5c7859 |
| institution | Directory Open Access Journal |
| issn | 1607-551X |
| language | English |
| last_indexed | 2024-12-13T14:02:52Z |
| publishDate | 2009-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Kaohsiung Journal of Medical Sciences |
| spelling | doaj.art-a1d68934f9ef4504bfa2c312af5c78592022-12-21T23:42:41ZengWileyKaohsiung Journal of Medical Sciences1607-551X2009-01-012511910.1016/S1607-551X(09)70033-6Children Presenting at the Emergency Department With Right Lower Quadrant PainChien-Heng Lin0Jeon-Hor Chen1Tsai-Chung Li2Yung-Jen Ho3Wei-Ching Lin4Department of Pediatrics, Jen-Ai Hospital, Taichung, TaiwanDepartment of Radiology, China Medical University Hospital, Taichung, TaiwanBiostatistics Center, China Medical University, Taichung, TaiwanDepartment of Radiology, China Medical University Hospital, Taichung, TaiwanDepartment of Radiology, China Medical University Hospital, Taichung, TaiwanRight lower quadrant (RLQ) pain is a common complaint in children presenting at emergency departments. This study analyzed the etiologies of RLQ pain, and compared the clinical presentations, laboratory test results and imaging findings in patients with appendicitis with those in other groups of patients. We also investigated if active observation resulted in delayed diagnosis, to the detriment of patients. Medical records for the period January 2006 to July 2006 were reviewed for children (age < 18 years) who presented to the emergency department of one medical center, complaining of RLQ pain. Out of a total of 100 patients (age range: 2–17 years; mean: 11 years), 46 patients presented with only one symptom of RLQ pain, while 32 patients had ≥ 2 associated signs or symptoms, including fever, nausea/vomiting, diarrhea, or rebound tenderness. Imaging studies, including abdominal sonography and/or computed tomography, were performed in 73 patients; 44 underwent surgery for presumed appendicitis and one received surgery for a right paraduodenal hernia. Eleven patients underwent surgery because of peritoneal signs, and eight because of persistent or aggravated RLQ pain. Postoperative pathologic examinations revealed 53 cases of appendicitis, six normal appendices, and other morbidities (1 perforated peptic ulcer, 1 pelvic inflammatory disease, 1 ovarian cyst, 1 diverticulitis, and 1 right paraduodenal hernia). Thirty-three patients were discharged after several hours of observation (range: 0.5–18 hours; mean: 4 hours), and three patients were admitted for further observations. All were discharged without operation. There were significant differences in the incidences of fever (p = 0.004) and rebound tenderness (p = 0.019), and in white cell counts (p < 0.001), neutrophil percentages (p < 0.001), and C-reactive protein levels (p < 0.001) between patients with appendicitis and patients with other causes of RLQ pain. Clinical signs and symptoms, laboratory tests, and imaging studies can be used to differentiate between the causes of RLQ pain. Patients without the classical features of appendicitis or peritonitis can be safely managed by active observation and repeated physical examinations.http://www.sciencedirect.com/science/article/pii/S1607551X09700336childrenemergency departmentright lower quadrant pain |
| spellingShingle | Chien-Heng Lin Jeon-Hor Chen Tsai-Chung Li Yung-Jen Ho Wei-Ching Lin Children Presenting at the Emergency Department With Right Lower Quadrant Pain Kaohsiung Journal of Medical Sciences children emergency department right lower quadrant pain |
| title | Children Presenting at the Emergency Department With Right Lower Quadrant Pain |
| title_full | Children Presenting at the Emergency Department With Right Lower Quadrant Pain |
| title_fullStr | Children Presenting at the Emergency Department With Right Lower Quadrant Pain |
| title_full_unstemmed | Children Presenting at the Emergency Department With Right Lower Quadrant Pain |
| title_short | Children Presenting at the Emergency Department With Right Lower Quadrant Pain |
| title_sort | children presenting at the emergency department with right lower quadrant pain |
| topic | children emergency department right lower quadrant pain |
| url | http://www.sciencedirect.com/science/article/pii/S1607551X09700336 |
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