Outcome after exploratory laparoscopy for unexplained abdominal pain in childhood
E. J. Hoffenberg, S. S. Rothenberg, D. Bensard, J. M. Sondheimer and R. J. Sokol
Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.
BACKGROUND: Abdominal pain in childhood is common yet frustrating when
unexplained. OBJECTIVE: To describe the clinical features and outcome of 8
children (6 girls and 2 boys; mean[+/- SD] age, 13 +/- 2 years) with
unexplained abdominal pain who underwent exploratory laparoscopy. SETTING:
All 8 patients were examined at an academic pediatric gastroenterology
center and referred for exploratory laparoscopy because of unexplained
abdominal pain. Laparoscopy was offered after family agreement to pursue
behavioral management if the pain and disability did not improve. RESULTS:
In all 8 children, laparoscopy detected an anomaly at a site corresponding
to that of the abdominal pain. Findings were adhesions in 7 children (3
colonic, 2 ileocecal, 1 gastric, and 1 appendiceal) and ovarian torsion in
1 child. At a mean follow-up of 12.6 months, the abdominal pain had
completely resolved in 6 children, notably improved in 1 child, and
continued unchanged in 1 child. Disability completely resolved in 2 of 3
children. CONCLUSIONS: In children with unexplained abdominal pain that is
acute in onset, well described, and suggestive of peritoneal involvement,
exploratory laparoscopy (1) successfully ends the cycle of abdominal pain
in most cases; and (2) commonly identifies abnormalities, usually
adhesions. However, whether laparoscopy, the placebo effect, or both
promote the healing process is unclear. Further study is needed to develop
criteria for referral for laparoscopic evaluation of unexplained abdominal
pain.
