Abdominal pain as a predictor of pneumonia in children

Abstract

Introduction: The abdominal pain may occur in children with pneumonia. When it is present, becomes an important symptom because it focuses attention on digestive tract tending to cause errors in diagnosis.

Methods: We prospectively studied 258 children ages 3 to 14 years who were admitted to the hospital with a diagnosis of pneumonia.

Results: The dominant initial clinical presentation in 22 (8,5%) of the patients was acute abdominal pain. Mean duration of the pain was 17,9 h (range 2 h to 2 days) before the diagnosis of pneumonia was established. Respiratory rate on admission >40 was in 14/22 (63,6%) of the patients. Seventy-three percent of the patients had temperature between 38 and 40°C. WBC ≥ 15000/mm³ was seen in 15/22 (68,2%). Auscultation abnormalities were present in 17/22 (77,3%) patients. The diagnosis was confirmed in all by chest radiography. It was observed that left-sided pneumonia is capable of mimicking appendicitis almost frequently as right-sided pneumonia. All abdominal symptoms disappeared in all children following the treatment of pneumonia, and no sequelae were observed.

Conclusions: In children presenting with acute abdominal pain, pneumonia must also be considered as a possible cause. However, chest radiography should be performed in a child with abdominal pain of unknown cause, especially if there are respiratory symptoms, fever and increased white cell count. Prompt diagnosis is essential, not only to avoid surgical intervention but also to start therapy early and to prevent possible complications of pneumonia.