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1、22PEMdatabase.OrgPediatricAbdominalEmergenciesLorenG.Yamamoto,MD,MPH,MBA,FAAP,FACEPPediatricabdominalemergenciesarechallengingdiagnosticentities(1).Wheneveracorrectdiagnosisismade,agreatdealofsatisfactionresultssincesignificantmorbidityandmortalityisavoided.Yet,thesediagnosticentities
2、aredifficult,resultinginfrequentmisdiagnosesandconsequentmorbidityandmortality.Thepurposeofthisessayistofamiliarizethereaderwiththeseentitieswhichincludeappendicitis,intussusception,malrotationwithmidgutvolvulusandMeckel'sdiverticulum.Foralloftheseconditions,anearlydiagnosisisassociat
3、edwithasubstantiallybetteroutcome,comparedtoalatediagnosis.Althoughthereareotherabdominalemergencyconditions,thisessaywillbelimitedtocoveringthesefourtopics.22AppendicitisAppendicitisisthemostcommonoftheseriousabdominalconditions.Withoutquotinganactualincidencefigure,itisonlyimportant
4、torealizethatchildrenwithappendicitiswillbeencounteredfrequently,especiallyinanemergencydepartment.Thismakesappendicitisoneofthemostcommonseriouspediatricconditionstobeencountered.Parent/patientexpectationsregardingappendicitisareunforgivinginthatsincemostlayperonshaveheardofappendici
5、tisandhaverelativesorfriendswhohavehadappendicitis,thisshouldbeaveryeasydiagnosistomakeinthemindsofmostparents/patients.Unfortunately,thediagnosisofappendicitisisdifficulty.Themisdiagnosisrateisdifficulttodeterminesincenoonelikestobragabouttheirhighmisdiagnosisratesintheliterature.How
6、ever,itmaybeashighas50%,whichmeansthatroughly50%ofthepatientswhohaveappendicitis,haveseenaphysicianonapreviousencounterforwhichadifferentdiagnosis(amisdiagnosis)wasgiven.Thisisprobablybecauseroughly50%ofthecasespresentinanatypicalfashion.Themoreatypicaltheclinicalpresentationis,themor
7、elikelyitis,thataphysicianwillmisdiagnosethecase(1-6).Addingtothedifficulty,isthatpatientsfrequentlypresentveryearlyintheirclinicalcourse,whenonlymildandlessspecificsymptomsmaybepresent.Infantsandyoungchildrenareespeciallydifficulttoevaluatesincetheycan'tspeakandtheirexaminationisdiff
8、icult
