Atypical Pediatric Acute Abdomen: Diagnostic Imaging Strategies and Minimally Invasive Surgical Decision-Making

Resumen

Atypically presenting pediatric abdominal emergencies represent a significant diagnostic and therapeutic challenge because potentially severe surgical conditions may initially manifest through nonspecific, incomplete, or misleading symptoms. This study analyzed the role of diagnostic imaging and minimally invasive surgery in the management of acute appendicitis, intussusception, intestinal obstruction, intestinal malrotation with midgut volvulus, symptomatic Meckel diverticulum, and adnexal torsion in pediatric patients. A descriptive, analytical, and comparative review of recent scientific evidence was conducted using the Scientific Method and integrating systematic reviews, meta-analyses, clinical guidelines, radiological studies, and pediatric surgical literature. The findings showed that ultrasound is the preferred first-line imaging modality in most hemodynamically stable children because of its diagnostic usefulness and absence of ionizing radiation. When ultrasound is inconclusive and clinical suspicion persists, selective use of magnetic resonance imaging, computed tomography, contrast studies, repeat ultrasonography, or early surgical consultation may improve diagnostic accuracy. The analysis also demonstrated that clinical deterioration, peritonitis, suspected ischemia, perforation, or threatened organ viability should override routine sequential imaging and prompt urgent surgical assessment. Minimally invasive surgery plays an important diagnostic and therapeutic role in several pediatric abdominal emergencies, particularly appendicitis, symptomatic Meckel diverticulum, adnexal torsion, and selected cases of malrotation or bowel obstruction. However, open surgery remains necessary in the presence of hemodynamic instability, extensive ischemia, necrosis, perforation, severe bowel distension, or complex anatomy. The evidence supports an integrated and severity-adapted approach based on early recognition of atypical presentations, ultrasound-first imaging when appropriate, selective diagnostic escalation, timely surgical decision-making, radiation minimization, and preservation of viable organs and tissues.