Chronic abdominal pain of childhood

Abstract

Chronic abdominal pain of childhood occupies a significant portion of any pediatric practice. It has been estimated that one out of three children seen on a daily basis in any busy pediatric practice will have a component of abdominal pain. Fortunately, the vast majority of these children have acute pain that either resolves spontaneously or is amenable to appropriate consultation and intervention. Only a very small number of these children persist with what is known as chronic abdominal pain of childhood (CAP). This syndrome has been described quite rigorously in the pediatric gastroenterology literature as abdominal pain that persists for more than 3 months and is disabling with multiple absences from school and avoidance of normal childhood activities. A profile has been developed for a typical child with CAP. These children are generally adolescents and are predominantly female. Their pain is often aching and located periumbilically; it occasionally awakens them at night. Approximately half the children will be bothered by persistent diarrhea or constipation and very often there is a significant, usually maternal, family history of similar complaints (Silverberg 1991). Chronic abdominal pain is not only a problem of childhood, and the adult gastroenterologic and surgical literature is replete with studies discussing the appropriate evaluation and treatment of disabling abdominal pain in adults. The advent of pediatric laparoscopy has provided us with an additional means of extending our diagnostic armamentarium with a procedure that is relatively easy to perform and has a demonstrated low surgical risk. The technique is generally the same as previously described for laparoscopic appendectomy but also includes a careful and organized laparoscopic exploration of the peritoneum. © Springer-Verlag Berlin Heidelberg 2008.