Polito Cesare, La Manna Angela, Signoriello Giuseppe, Marte Antonio
Department of Pediatrics, Second University of Naples, 80138 Naples, Italy.
Pediatrics. 2009 Dec;124(6):e1088-94. doi: 10.1542/peds.2009-0825. Epub 2009 Nov 9.
Our goal was to establish the clinical presentation and features of pain attacks in children with recurrent abdominal pain (RAP) and urolithiasis.
We compared the rate of previous appendectomy among 100 consecutive patients with that of 270 control subjects. We also compared the frequency of pain attacks with that reported by children with functional or organic gastrointestinal RAP.
Fifty-three patients had no history of dysuria or gross hematuria, and only 35 had hematuria at the first visit; 41 patients were evaluated for urolithiasis only because of a family history of kidney stones associated with RAP. Twenty-nine patients had been previously hospitalized for abdominal symptoms. Sixteen patients and 4 control subjects (1.5%) had undergone a previous appendectomy (P < .0001). Two to 28 months before the diagnosis of urolithiasis, 37 patients underwent abdominal ultrasonography, which did not show urinary stones. Sixty-nine percent of subjects younger than 8 years of age had central/diffuse abdominal pain. The mean frequency of pain attacks was 4 to 9 times lower than in patients with functional or organic gastrointestinal RAP.
Because of the inconstant occurrence of dysuria and hematuria, the location of pain in areas other than the flank, and the lack of calculi shown on imaging studies performed after pain attacks, the urologic origin of pain may be overlooked and ineffective procedures performed. The possibility of urolithiasis should be considered in children with RAP who have a family history of urolithiasis and/or infrequent pain attacks, even when dysuria and hematuria are lacking, and in younger children even when pain is not lateral.
我们的目标是确定复发性腹痛（RAP）和尿路结石患儿疼痛发作的临床表现及特征。
我们比较了100例连续患者与270例对照受试者既往阑尾切除术的发生率。我们还将疼痛发作频率与功能性或器质性胃肠道RAP患儿报告的频率进行了比较。
53例患者无排尿困难或肉眼血尿病史，初诊时仅有35例有血尿；41例患者仅因与RAP相关的肾结石家族史而接受尿路结石评估。29例患者既往因腹部症状住院。16例患者和4例对照受试者（1.5%）曾接受过阑尾切除术（P<0.0001）。在尿路结石诊断前2至28个月，37例患者接受了腹部超声检查，未显示尿路结石。69%的8岁以下受试者有中腹部/弥漫性腹痛。疼痛发作的平均频率比功能性或器质性胃肠道RAP患者低4至9倍。
由于排尿困难和血尿的发生不恒定、疼痛部位不在侧腹以及疼痛发作后影像学检查未显示结石，疼痛的泌尿外科病因可能被忽视，从而进行无效的治疗。对于有尿路结石家族史和/或疼痛发作不频繁的RAP患儿，即使没有排尿困难和血尿，以及对于年龄较小的患儿，即使疼痛不在侧腹，也应考虑尿路结石的可能性。
