THE MANAGEMENT OF ACUTE ABDOMINAL PAIN IN CHILDREN

The beautifully written article by Simpson and Smith (J. Paediatr. Child Health 1996; 32: 1 10-1 12) published under the above title should more properly have been titled: ‘The diagnosis of acute appendicitis in children’. Although it did mention the 70% of cases that did not have an initial diagnosis of acute appendicitis, the article focused upon the 30% that did. It then ascertained that in more than 80% of the 30% the final diagnosis was not appendicitis. Almost no comment was made about the 94% of cases that were diagnosed as not having appendicitis. I am reminded of a young girl who presented 13 times to the emergency department of this hospital with episodes of abdominal pain before a resident sought paediatric assessment which ascertained that she had been the victim of persistent sexual abuse. The abdominal pain in that case served as a metaphor for the bad things that were happening down there. Psychosocial assessment is an essential investigation for unexplained abdominal pain. In their final paragraph the authors expressed the opinion that ‘no investigations should be necessary in the majority of children with abdominal pain’ (p. 112). Although I recognise that they were referring to procedural investigations I believe that the wording was most unfortunate in perpetuating the myths that ‘if it isn’t organic it doesn’t matter’, and ’if it isn’t procedural then it isn’t an investigation’. In 1996 the journal should be able to do better. the logical conclusion of the pain. It is with this practice that unnecessary surgery can be avoided.