Abdominal pain is a common symptom in children, and can have a myriad of causes, ranging from problems that get better on their own to medical or surgical emergencies. Clues to the underlying cause of a child’s abdominal pain include the age of the child, the type of pain -- sharp, dull or crampy, and the duration of the pain. Additional clues include whether the pain has accompanying symptoms such as vomiting or fever, and the location of the pain. Left-sided abdominal pain is most often caused by problems in organs located on the left side, such as the spleen, the left ovary or testicle, and the left side of the large intestine.
Acute Left-Sided Pain That Can Occur Throughout Childhood
Several causes of left-sided abdominal pain cause sudden and often severe pain. For example, the spleen – an organ that makes and filters blood cells, and helps fight infection -- is located in the upper left abdomen. Blunt trauma to this part of the abdomen, or even the mid back, can cause injury to the spleen resulting in pain (Ref 1, Etiology section). Moreover, trauma to the spleen can result in a tear of the surrounding capsule, causing severe blood loss from the spleen (Ref 4, p. 1526), a medical emergency. The spleen can also become infected or enlarged, by causes such as Epstein Barr virus infection or congestion from abnormal cells in sickle cell disease, causing left upper abdominal pain. Appendicitis is usually a cause of right-sided abdominal pain, but can actually cause left-sided pain in the rare case of a child born with the appendix located on the left-side of the abdomen (Ref 6, background section).
Acute Left-Sided Abdominal Pain in Older children
Twisting of the left ovary, which is called ovarian torsion, will usually cause intermittent sharp abdominal pain that also may radiate down the left leg (Ref 4, p 1668), usually in girls age 12 years and over (Ref 1, Table 2). Pain occurs because the nerves around the ovary are inflamed. Ovarian torsion is an emergency because of the possibility of loss of the ovary due to impaired blood supply. The same problem of twisting can occur in the left testicle—which most commonly occurs in boys age 12 and over. Since the testicle, unlike the ovary, is visible, a parent may notice the tell-tale signs of scrotal swelling, tenderness and discoloration (Ref 4, p. 1651-1652).
Chronic Left-Sided Abdominal Pain
Constipation, a common cause of left-sided abdominal pain, is characterized by stools that are infrequent or difficult to pass. The pain is often cramping, and relieved by a bowel movement. Other than abdominal pain, symptoms of constipation that a child may experience include pain during stooling, blood on the stool or tissue paper after wiping, fecal soiling and wetting himself (Ref 2, p. 2). Risk for constipation is increased when a child’s diet is lacking adequate fiber sources, such as vegetables, fruit and whole grains (Ref 3). A left groin hernia can cause abdominal pain. A hernia occurs when abdominal organs, usually the intestine, enter the groin through an opening in the abdominal wall. Parents may notice a bulge in the child’s groin. Half of these cases occur in children under 1 year old. A groin hernia can cause acute pain and become an emergency if it gets trapped in the abdominal wall -- called an incarcerated hernia -- because it chokes off blood flow to the trapped organ (Ref 4, p 1185 -1187).
If a child has abdominal pain that is moderate to severe, that is worsening, or that is constant, her doctor should be notified immediately (Ref 5,’When to Call’). Other red flags include blood in the vomit or stool, recent injury to the abdomen, high fever or age under 2 years old (Ref 5, ‘When to call’).
- American Family Physician: Acute Abdominal Pain in Children
- Italian Journal of Pediatrics: Constipation in Children
- HealthyChildren.org: Abdominal Pain in Children
- Nelson Textbook of Pediatrics, 16th Edition; Robert M. Kliegman M.D., et al.
- HealthyChildren.org: Abdominal Pain
- BMJ Case Reports: Left-Sided Appendicitis in Children with Congenital Malrotation: A Diagnostic Pitfall in the Emergency Department