The abdominal exam in children starts with the general assessment; the Pediatric Assessment Triangle:
Good lighting and exposure are important
Your approach will be based on the child’s developmental stage:
Review of abdominal surgical scars in adults:
Immediate, full access to the abdomen: trauma, shock statesOpen appendectomyAlternate (more cosmetic) open appendectomyNephrectomyOpen cholecystectomyPancreatic cancer; Whipple procedureLiver transplantRenal transplantChildren’s abdomens are smaller, organs more compact; abdomen more convexRare to perform midline laparotomyMore common: smaller incisions in transverse approach give more visualization in childrenFrom Shalaby et al.Renal transplantYour pediatric patient’s belly may be a roadmap of suffering… follow the signs
Selected Reference
Shalaby R, Ismail M, Gouda S, Yehya AA, Gamaan I, Ibrahim R, Hassan S, Alazab A. Laparoscopic management of recurrent inguinal hernia in childhood. J Pediatr Surg. 2015 Nov;50(11):1903-8. doi: 10.1016/j.jpedsurg.2015.07.015. Epub 2015 Jul 26. PMID: 26472657.
