In this section
Abdominal pain - chronic Adolescent gynaecology - lower abdominal pain Acute scrotal pain or swelling Constipation Vomiting
Causes of abdominal pain by age
Conditions requiring urgent medical or surgical management
Other common causes
Neonates
Intussusception Necrotising enterocolitis Volvulus Incarcerated hernia Testicular torsion Sepsis Hirschsprung associated enterocolitis (HAEC)
Dietary protein allergy
Infants and children
Abdominal trauma Appendicitis (see Appendicitis in young children <5 years old under additional notes) Foreign body ingestion (eg button battery) Intussusception Pyloric stenosis Volvulus Testicular torsion Ovarian torsion Incarcerated hernia Toxin ingestion DKA Sepsis Malignancy (eg neuroblastoma, Wilms tumour)
Constipation Gastroenteritis Urinary tract infection Mesenteric adenitis Epididymitis Henoch-Schönlein purpura Hip pathology Migraine Myocarditis/pericarditis Respiratory tract infections (tonsillitis/pharyngitis, pneumonia) Hepatitis Meckel's diverticulitis
Adolescents
Abdominal trauma Appendicitis Ectopic pregnancy Ovarian cyst - torsion/rupture Testicular torsion DKA Sepsis Primary bacterial peritonitis
Constipation Gastroenteritis Urinary tract infection Cholecystitis/ Cholelithiasis Pancreatitis Hepatitis Inflammatory bowel disease Pelvic inflammatory disease Renal calculi Epididymitis Hip pathology Migraine Myocarditis/pericarditis
*Peritonism:
Most children need no investigations Targeted investigation is directed by the likely differential diagnoses. These may include:
Treatment will be guided by the likely cause
Child requires care beyond the comfort level of the local hospital. Note: Prior to transferring infants or children with possible surgical conditions, ensure the child has adequate analgesia, venous access and intravenous fluids
For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services
Abdominal pain
Appendicitis in young children <5 years old
Causes of abdominal pain based on pain characteristics and associated symptoms
Quality
Causes
Sudden onset
Testicular or ovarian torsion/rupture Intussusception Volvulus Perforated viscus Incarcerated hernia
Episodic/colicky
Constipation Gastroenteritis Intussusception Mesenteric adenitis Ovarian torsion
Dull, increasing severity and localisation
Appendicitis
Location
Epigastric or right upper quadrant
Pancreatitis Cholecystitis Cholelithiasis Gastritis/peptic ulcer disease Pleural effusion Pneumonia
Central/periumbilical
Constipation Gastroenteritis Mesenteric adenitis Bowel obstruction Intussusception
Right lower quadrant
Appendicitis Ectopic pregnancy Ovarian cyst - torsion/rupture Intussusception Incarcerated hernia
Left lower quadrant
Constipation Ectopic pregnancy Ovarian cyst - torsion/rupture Inflammatory bowel disease Hirschsprung associated enterocolitis (HAEC) Incarcerated hernia
Associated symptoms
Bloody diarrhoea
Gastroenteritis Meckel diverticulum Inflammatory bowel disease
Bilious vomiting
Volvulus Obstruction
Polyuria, polydipsia, weight loss
DKA
Dysuria, frequency and fever
Urinary tract infection
Vomiting and diarrhoea
Gastroenteritis
Vomiting without diarrhoea
Urinary tract infection Obstruction Volvulus Ovarian torsion
Cough, fever, SOB
Pleural effusion Pneumonia
Underlying condition
Potential complications causing abdominal pain
Hirschsprung disease
Enterocolitis
Cystic fibrosis
Liver disease and/or ascites
Primary bacterial peritonitis
Nephrotic syndrome
Splenectomy
VP shunt
Peritoneal dialysis
Chemotherapy
Pancreatitis
On immunosuppressants
PEG/NG/NJ fed
Inflammatory bowel disease (especially if concurrent Clostridium difficile)
Toxic megacolon
Immunocompromised
Sickle cell disease
Vaso-occlusive crisis
Cholecystitis
Obesity
Cholelithiasis
Spina bifida/coeliac disease
Constipation
Previous surgery
Bowel obstruction
Last updated April 2024