Imaging of the acute abdomen in the pediatric patients

The acute abdomen and pelvis is a serious clinical condition which may require urgent surgery. The potential causes of the acute abdomen and pelvis in pediatric patients are numerous, as in adults, and diagnosis is often delayed due to misleading signs and symptoms. Clinical signs and symptoms are often nonspecific; abdominal and pelvic pain and abdominal distention are common in a wide variety of disorders. Other signs and symptoms can include bilious vomiting, other signs of intestinal obstruction, urinary tract signs, fever, and weakness. Although in adult patients with an acute abdomen/pelvis, computed tomography (CT) is the mainstay of diagnosis and for discriminating conditions requiring surgery from those which can be treated conservatively, the use of CT in pediatric patients in recent years has decreased due to the potential risks of radiation exposure. The role of ultrasound (US) has become increasingly important. US does not use ionizing radiation, is usually readily available in emergency departments, is inexpensive, is portable, and does not require patient sedation. Furthermore, US allows assessment of intestinal peristalsis, and allows compression of the bowel. Magnetic resonance imaging (MRI) also does not use ionizing radiation, and can be used to diagnose a wide variety of pediatric acute abdominal and pelvic conditions, but MRI is more expansive, is not always available in emergency departments, and often requires sedation of pediatric patients to obtain good-quality images. Despite this, in line with radioprotection criteria, MRI should be considered as an alternative to CT, for its excellent ability to depict the causes of acute abdominal and pelvic disease, to provide valuable assistance in differential diagnosis, and for evaluation of any complications.