Adam Szarszewski, Katarzyna Plata-Nazar, Stefan Popadiuk, Maria Korzon
CaseRepClinPractRev 2002; 3(3):166-169
Background: Acute abdominal pains, suggestive of ‘acute abdomen syndrome’ are sometimes observed in non- compensated diabetes. However, a reversed situation in which stress associated with acute abdominal disorders
results in disturbances of carbohydrate metabolism mimicking diabetes is reported very seldom. The report describes two cases of hyperglycemia in children with mechanical impatency of the gastrointestinal tract due to
small intestinal strangulation.
Case reports: Case 1. A 5-year-old boy was admitted to hospital with abdominal pains and vomiting. During 4 weeks preceding hospitalization he had complained of thirst and frequent micturition. A pediatric surgeon saw
no indications for surgical intervention. Laboratory tests revealed, i. a. the presence of glucose in urine and elevated serum glucose level. The child was referred to the Clinic of Endocrinology. Several hours later, the patient’s
condition markedly aggravated. With positive peritoneal signs, he was transferred to the surgical ward. Life-saving laparotomy was performed, leading to the diagnosis of mechanical intestinal impatency due to
strangulation, mesenteric torsion, and small intestine necrosis. Case 2. An 11-year-old boy was seen with severe paroxysmal abdominal pains of several hours’ duration. Two months before the patient had undergone abdominal
surgery because of gangrenous appendicitis. On the day of admission vomiting was observed. Physical examination revealed abdominal tenderness on palpation. The peritoneal signs were negative. Laboratory tests
revealed hypokaliemia, non-compensated metabolic acidosis, hyperglycemia, glycosuria. Abdominal examinations with imaging techniques demonstrated no signs of gastrointestinal impatency. The case was consulted several
times with a pediatric surgeon who did not consider the clinical picture to be typical of an acute abdominal disorder. The child was referred to the Clinic of Endocrinology. Over ten hours later, the patient’s condition markedly aggravated. He was transferred to the surgical ward. Life-saving laparotomy revealed mechanical intestinal impatency due to strangulation, mesenteric torsion, and small intestine necrosis (120 cm).
Conclusions: Not only diabetes, but also diabetes-mimicking symptomatic hyperglycemia should be taken into consideration in the diagnostics of acute abdomen syndrome associated with hyperglycemia in children. Overlooking
this possibility can lead to unfavorable delay of surgical treatment.
Keywords: Hyperglycemia, acute abdomen syndrome