1. Pediatric Acute abdominal pain

3. Left scrotal swelling (+), tenderness
Case 1
15 y/o boy, no underlying disease
Sudden severe lower abdominal pain, especially LLQ area, persistent, onset at midnight
No fever, no other associated symptoms, no significant relieving factor
More severe pain while 左側躺
Left scrotal swelling (+), tenderness

4. Testicular torsion  Emergent OP
Consult Urologist
Cremasteric reflex(-)
Bedside echo: decreased blood flow
Testicular torsion  Emergent OP
Patients classically present with an abrupt onset of severe testicular or scrotal pain, usually of less than 12 hours' duration
However, inguinal or lower abdominal pain may be the presenting complaint

5. Case 2 16 y/o girl Lower abdominal pain for half day, RLQ > LLQ
Tenderness(+), rebounding pain(+)
No fever, no nausea, no vomiting
Psoas sign(-), Obturator sign(-)

6. Lab

7. Alvarado score: 6~7
Abdominal echo not favored acute appendicitis

8. GYN Denied sexual exposure LMP: 3 weeks ago U/P: negative Consult GYN
Suspect Lutein cyst rupture (Transabdominal echo: right adnexa cyst: 2.3cm, cul-de-sac fluid: 1.8cm)
Recheck Hb
Add Transamin
OPD f/u

9. Case 3
11 month old infant
Intermittent vomiting since yesterday morning
no fever, mild watery diarrhea, no blood or mucoid content initially
General weakness  ER
Intermittent irritibility

10. Suspect Current Jelly stool

11. KUB

12. Abdominal echo

13. OP
Intussusception, ileocecal valve
Resection of ischemic small bowel

14. Thank you!