Benefit of rectal examination in children with acute abdomen

Background: Acute abdomen is a condition that often mandates urgent treatment. PR or DRE (per rectal examination or digital rectal examination) is one of the fundamental physical examinations that doctors use to differentiate causes of acute abdominal pain. However, it is not a pleasant examination to undergo. Sometimes doctors ignore this examination. The benefit of per rectal examination has rarely been studied in children. Objective: This study was designed to demonstrate the benefit of rectal examination for contribution to the diagnosis of acute abdominal pain in children and reduction of unnecessary operation. Material and Method: A prospective cross sectional study of children ages 3 to 15 years old who presented with acute abdominal pain from January 2012 to December 2013 was conducted. The clinical parameters including DRE results were correlated to the diagnosis. The diagnoses prior to and after DRE were compared. The accuracy of DRE was analyzed by pair response analysis of pre and post-DRE results using McNemar‘s Chi-square test. Results: A total of 116 children with acute abdominal pain were enrolled in the study. The final diagnoses were appendicitis accounting for 27%, constipation 28%, non-surgical gastrointestinal diseases such as gastritis, diarrhea and food poisoning 9%, diseases of the female reproductive system 7% and others 29%. In comparing the diagnoses prior to and after digital rectal examination, it was demonstrated that rectal examination significantly helped differentiate diagnosis in 38.8% of patients, whereas 19% of the patients gained no benefit.DRE corrected the diagnosis in 45 cases which was significantly higher than misguiding the diagnosis in 3 cases. The efficacy of DRE was true positive rate of 81% and false positive rate of 19%. In subgroup analysis of 81 patients with suspected appendicitis, which accounted for 70% of patients with acute abdominal pain, DRE helped in the diagnosis which reduced unnecessary surgery in 32% of these patients. Conclusion: The presented study recognizes the benefit of DRE as a guide in the diagnosis of pediatric acute abdominal pain which reduces unnecessary investigation and operation. It should be considered as an essential part of complete physical examination in patients with acute abdominal pain before proceeding to imaging investigation.