(June 26, 2008 - Insidermedicine) Welcome to Insidermedicine's If I Had, where we get a chance to ask an expert what they would do if they had a medical condition.
On a recent trip to Palo Alto, we met up with Dr. Sanjeev Dutta, MD, MA, FRSC(C), FACS, who is an Assistant Professor of Surgery and Pediatrics at the Stanford University School of Medicine. Dr. Dutta is also the Surgical Director of the Intestinal Rehabilitation Program at Lucile Packard Children’s Hospital.

When should one worry about abdominal pain in a child?
If I had a child with abdominal pain, the first thing I would do is just watch for a short period of time. By short period of time I mean a few hours. Worrisome things are if the abdominal pain is persistent, if it is becoming localized to one area of the abdomen. So at first the child complains of a belly achiness but then says; “my pain is really starting to go to just the right side, the lower right side, and it’s just staying there.” Feel free to examine your child, press on the belly, ask where it hurts. If it is hurting in one specific place, that’s a worrisome symptom. If the pain is not getting better, if the pain is getting worse, and if the pain is staying in one particular location, those are all things that I would consider reasons to go see a doctor.

How urgently should I seek medical attention?
Well I think that you can never go wrong with the adage of seek medical attention as quickly as possible. And that would be my advice because as a parent you are not a doctor and you are not expected to doctor your child. What you are expected to do though is get appropriate help when they need it. And I think that if you are worried about their abdominal pain you should go see a doctor as soon as you can. Other worrisome signs are things like vomiting. Particularly if their vomit is green in color. We call that bile vomiting, and that’s a very concerning sign, surgeons, we would want to see that child as quickly as possible. Any blood in the stool or severe diarrhea are also concerning. Any one of those things, if they are not getting better, or they are getting worse, need to be seen by a doctor.

In the emergency room, which diagnostic tests should be ordered?
In the emergency room, one of the main diagnostic tests is the doctor having a thorough review of the history and examining the child. I think that is critically important. And by review of the history, what I mean is give the doctor as much information as you possibly can. You can never give too much information. Particularly with a child as the child is not able to communicate as effectively as an adult may be able to. As the parent you’re that child’s voice, so give as much information as possible in terms of the history. Once the doctor has examined the child and has taken the history,  then he will probably elect to some sort of blood work, and some sort of imaging. Blood work typically means a small amount of blood is taken and they look at the white blood cell count, which is a measure of infection. With imaging typically it starts with an x-ray of the abdomen and that often progresses to either an ultra-sound or a CT scan of the abdomen.

What are the indications for surgery?
That’s a complex question because there are so many different reasons why we might do an operation. And there are so many different diseases that can cause abdominal pain. But in general we will do an operation  when we have confirmed with the history and the tests that we’ve done, or we have a high suspicion that there is a some sort of problem in the abdomen that is not going to get better with medicine alone. That is sort of the very vague or broad answer to your question. Operations what they do is help the body to heal. By removing a part of the body or by rearranging it a little bit we are able to help the body heal itself.

How has abdominal surgery changed? What can patients expect post-operatively?
I think that the biggest way that surgery has changed is once again the approach that surgeons have to an operation as I have mentioned, big surgeon, big incision, used to be the way that surgeons would think. By that I meant that by making a big incision, by doing a big operation somehow you are a more competent surgeon. I’m glad to say, delighted to say that is completely not the case anymore. I think that we can still be sensitive to our patients and to the quote “trauma” that we give to out patients by being minimalistic in our approaches but still maximally effective in our operations. This brings us to minimal access surgery, which is an area that I concentrate on very heavily. Finding new ways to do big operations in the body without leaving any big incisions.

If I had a child with acute abdominal pain…
If I had a child with acute abdominal pain I would watch them for a couple of hours, two or three hours. If they are getting worse, the pain is becoming localized to one part of their abdomen, or they are simply not getting better, they are not able to take in water and fluids, then I would seek medical attention immediately.