Approach to acute abdominal pain in children with non-specific clinical signs

Abstract

Acute abdominal pain is a common presentation in pediatric emergency departments, yet the diagnostic process becomes complex when children exhibit non-specific clinical signs. Young patients often struggle to localize pain or describe their symptoms accurately, and classical signs may be absent or misleading. This diagnostic ambiguity broadens the differential diagnosis, ranging from benign, self-limiting conditions to urgent surgical emergencies. Atypical presentations can mask serious pathology such as appendicitis, intussusception, or volvulus, increasing the risk of delayed intervention or unnecessary procedures. Physical examination alone frequently lacks sensitivity in these scenarios, especially in very young children or those with neurodevelopmental delays. Laboratory tests, including inflammatory markers, may aid in identifying children at risk but are rarely definitive in isolation. Imaging, particularly ultrasound, plays a key role but is highly dependent on operator expertise and patient cooperation. Computed tomography and magnetic resonance imaging offer greater diagnostic clarity but come with concerns over radiation exposure and accessibility, respectively. Risk stratification tools and clinical scoring systems help guide decision-making by categorizing patients into low-, intermediate-, or high-risk groups. While these tools can support safer disposition planning, their accuracy is reduced in patients with vague symptoms. Serial clinical assessment remains a cornerstone of safe management, allowing time-dependent pathologies to evolve into more recognizable patterns. In ambiguous cases, a balanced, multidisciplinary strategy that considers clinical progression, investigation findings, and resource availability is essential. Contextual factors such as institutional capabilities, parental input, and geographic access to pediatric care further shape the diagnostic pathway. Ultimately, a nuanced and vigilant approach is required to avoid missed diagnoses while minimizing unnecessary interventions in children with unclear abdominal presentations.