Pediatric emergency medicine trisk 3773 3773

early in the postoperative course or months or even years later. The child often
has the sudden onset of abdominal cramps, nausea, vomiting, and abdominal
distension. Although most intestinal obstructions from adhesions do not
jeopardize the perfusion of the bowel, occasionally a loop of intestine, caught
under a fibrous band or herniating through the adhesion, can become gangrenous.
All such patients need to be admitted to the hospital and evaluated by a surgeon
who should direct the complete management.

Chronic Partial Intestinal Obstruction
Any child with intermittent abdominal distension, nausea, anorexia, occasional
vomiting, or chronic constipation or obstipation may have partial intestinal
obstruction. A number of diagnostic considerations exist.
TABLE 116.3
DIFFERENTIAL DIAGNOSIS OF FUNCTIONAL CONSTIPATION AND
HIRSCHSPRUNG DISEASE
Functional constipation

Hirschsprung disease

Onset
History

<2 yrs
Coercive training
Colicky abdominal pain
Periodic volume stools

Encopresis
Abdominal
distension
Rectal examination

Barium
examination
Motility
Biopsy

Present
Absent or minimal

Birth
Enemas necessary
No abdominal pain
Episodes of intestinal
obstruction
Absent
Present

Feces-packed rectum
Dilated rectum

Empty rectum
Narrow segment

Normal
Ganglion cells

Abnormal
No ganglion cells

Chronic Constipation
Chronic constipation is probably one of the most common causes for abdominal

pain, distension, and vomiting in children. The history, if available from a reliable
parent, may attest to chronic constipation; however, occasionally, such a child is