Differential diagnosis of abdominal pain in childhood: a case report

Abstract

Acute abdominal pain is a major pediatric complain with a wide range of differential diagnoses. Pacient was two years and eight months, female, black, born in Itapeva, São Paulo, Brazil. She referred abdominal pain, diarrhea and cough for 16 days. She was hospitalized with a diagnosis of pneumonia. During hospitalization, she presented coughing, grunting, respiratory distress, vomiting, diarrhea, abdominal distension and fever. The bad evolution and worsening abdominal pain led to an abdominal tomography, which revealed appendix fecal calcifications. She was taken to the reference service, where there was suspicion of acute appendicitis and then surgery was performed. The final diagnosis was acute purulent appendicitis. The patient progressed as expected and was discharged ten days after surgery. Numerous disorders can cause abdominal pain; the most common causes are gastroenteritis and appendicitis. However, other differential diagnosis should be considered, including pneumonia. In the case reported, although the patient was initially tachydyspneic, she had severe abdominal pain and dehydration. A good medical history is essential. Laboratory abnormalities are nonspecific and occur in both cases. In cases in which pneumonia progresses with poor outcome, it is important to think about the possibility of another diagnosis, including appendicitis, if the complains include abdominal pain, due to its high morbidity and mortality.