Paediatric emergencies: non-traumatic abdominal emergencies.

Presentation with acute abdominal pain or abdominal symptopathology is a very common cause of presentation of children to hospital. The causes are dependent in part on the age of the child, in part on the presence of previous surgery, and can be divided into those that relate to congenital abnormalities at whatever age they present, acquired disease and infection. Children, particularly young children are often poor historians, and therefore the clinical examination and the laboratory investigations are important in helping to come to a diagnosis. Primary imaging of abdominal emergencies in childhood is a radiograph of the abdomen, followed by ultrasound. Further imaging depends on the results of these studies. An ordered review of the abdomen radiograph is important if the salient features on X-ray are not to be missed. Practitioners should be competent with abdominal ultrasound in children and know where to seek the causes of disease, as these are different from those that are obtained in many instances in adults. Familiarity with the likely causes is important. The three commonest causes of acute abdominal pain in childhood are, in young infants, intussusception, appendicitis and mesenteric adenitis. In older children, inflammatory bowel disease and ovarian pathology are also included. This article details the approach to imaging and the salient features of some of the conditions.

Iodixanol in paediatric gastrointestinal imaging: safety and efficacy comparison with iohexol.

Iodixanol (Visipaque) is a dimeric, non-ionic iodinated contrast medium that is isotonic with blood at all clinically relevant concentrations. Iodixanol was compared in a randomized, double blind, parallel group, phase III multicentre trial with a monomeric, non-ionic contrast medium, iohexol (Omnipaque), at two concentrations assessing safety, tolerability and radiographic efficacy during contrast enhanced gastrointestinal radiography examinations of children. 154 children entered the trial; 152 formed the safety population and 147 the efficacy population. All examinations were performed following standard departmental practice. Children were assigned into either a high or low concentration group (iodixanol, 150 mgI ml(-1) and 320 mgI ml(-1) vs iohexol, 140 mgI ml(-1) and 300 mgI ml(-1)). The primary outcome measure for efficacy was the overall quality of visualization, which was assessed using a 100 mm visual analogue scale (VAS). The secondary efficacy variables assessed were quality of contrast opacification, mucosal coating and overall quality of diagnostic information. Safety evaluation involved patient follow-up for at least 48 h. Taste acceptance was also assessed. There was no statistically significant difference between the two contrast media with regard to the primary and secondary efficacy variables assessed, although higher ratings were observed for iodixanol. The 100 mm VAS score overall was 86 mm for iodixanol and 82 mm for iohexol (95% confidence interval -2.56, 10.42). The frequency of adverse events was lower for patients receiving iodixanol. Adverse events, mainly diarrhoea, occurred in 12 patients (16.2%) in the iodixanol group and 28 patients (35.9%) in the iohexol group. This reached statistical significance (p=0.006). Overall, iodixanol is well suited for examinations of the gastrointestinal tract, giving good efficacy results and fewer adverse events than iohexol.