A 7-Year-Old Boy With Recurring Episodes of Abdominal Pain. Issue 7 (July 2020)

• Record Type: Journal Article
• Authors: Noble, Jennifer; Ledrick, David
• Is Part Of: Pediatric emergency care. Volume 36:Issue 7(2020)
• Publication Date: 2020-07
• Subjects: abdominal pain in children -- pediatric abdominal pain -- recurrent abdominal pain -- ureteropelvic junction obstruction -- UPJ obstruction -- Dietl's crisis; Pediatric emergencies -- Periodicals; 618.92002505
• DOI: 10.1097/PEC.0000000000002158
• Languages: English
• ISSNs: 0749-5161

Abstract

Abstract : Abstract: Recurrent abdominal pain is a relatively common complaint in children who present to the emergency department. The etiology is often thought to be psychogenic, with an underlying organic cause present in less than 10% of patients. Intermittent ureteropelvic junction obstruction is usually not considered in the differential diagnosis of recurrent acute abdominal pain in children, which can cause a significant delay in diagnosis. In this condition, intermittent obstruction of the flow of urine from the renal pelvis to the proximal ureter occurs, which causes intermittent acute colicky abdominal pain and vomiting. This acute event, often referred to as a Dietl's crisis, either subsides after several hours or prompts a visit to the emergency department. Management often focuses on the identification of psychosocial issues or constipation, and routine abdominal imaging is not a common practice. The frequency of these events over time and the duration of each acute event are 2 components that factor into determining the loss of function in the affected kidney. The purpose of this case report is to increase awareness of intermittent ureteropelvic junction obstruction as a cause of recurring episodes of acute abdominal pain in children. Emphasis in this case report is on Dietl's crisis, how it presents, and how it is diagnosed and managed.