December 27, 2024

10-year-old afebrile boy presents with abdominal pain for 2 days

By Med-Challenger · 1 minute read

A 10-year-old afebrile boy presents with a history of abdominal pain for 2 days. The pain is spasmodic, intermittent, usually periumbilical, and occasionally severe, but he has not been vomiting. His last bowel movement was yesterday and was reportedly hard and difficult to pass. His mother states that he has had similar episodes of pain on and off over the last 6 months, and these have often been accompanied by difficulty passing stool.

On physical examination, the patient appears well. The lower abdomen is distended, with a firm and mildly tender mass palpated in the left lower quadrant. There is no rigidity or guarding, and firm stool, but no lesion or mass, is palpable on rectal examination.

Upright abdominal x-ray reveals distension of the sigmoid and descending colon with stool; the rest of the bowel appears unremarkable.

What is the most appropriate management?

computed tomography to rule out malignancy
plain x-ray of the abdomen
immediate surgical consultation
administration of enema

The correct answer is:

administration of enema

Educational Objective:

Describe the appropriate management of constipation.

Key Point:

Management of constipation includes clean out, maintenance, and behavior modification.

Explanation:

This boy has constipation, which is one of the most common causes of abdominal pain and vomiting in children. Management of constipation requires 3 considerations: clean out, maintenance, and behavior modification.

Acute constipation is easier to manage because there are fewer functional problems. The acute management of constipation is usually relatively easy and requires primarily the cleaning out of stool. Most experts recommend an approach that includes stool softeners or laxatives from above and suppositories or enemas from below. In milder cases, only the administration of enemas is necessary to soften feces and stimulate defecation.

Reference:

Kliegman RM, et al. Motility disorders and Hirschsprung disease (chapter 332). In: Kliegman RM, et al, eds. Nelson Textbook of Pediatrics. 20th ed., 2016:1806-1812.

This question appears in Med-Challenger Pediatric Medicine Exam Review with CME

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