Decoding Non-Traumatic Acute Abdomen in Children: Insights from the Emergency Department of a Tertiary Hospital in Mogadishu, Somalia.

INTRODUCTION: Acute abdomen is characterized by acute and severe abdominal pain caused by intra-abdominal disease and often requires surgical intervention. Accurate diagnosis is difficult because of symptom similarity and diverse causes, such as appendicitis, intussusception, and mesenteric adenitis, which can present with overlapping symptoms in pediatric patients. The aim of this study is to analyze the causes, diagnosis, and outcome of non-traumatic acute abdomen in pediatric patients at a tertiary hospital in Mogadishu. METHODOLOGY: A retrospective cross-sectional study was conducted from January 1 to December 31, 2023, including 92 children aged 0-18 who presented with non-traumatic acute abdomen and received emergency surgical intervention. All definitive diagnoses were confirmed based on intraoperative findings. Statistical analyses were conducted using SPSS version 26.0, incorporating univariate and bivariate analyses with a significance level of p < 0.05. RESULTS: Out of 6390 pediatric emergency visits, 92 children (1.4%) were diagnosed with acute abdomen. The main reasons were appendicitis (53.3%), intestinal obstruction (16.3%), and perforation (15.2%). Appendicitis predominantly impacted school-aged children (72.7%) and adolescents (66.7%), whereas intussusception was more prevalent in newborns (40.0%) and toddlers (33.3%). Fever was strongly correlated with appendicitis (59.6%, p < 0.001) and perforation (25.0%, p < 0.001). Regarding diagnostic performance, plain radiography was negative in 71.4% of appendicitis cases, whereas ultrasonography demonstrated a significantly higher diagnostic yield of 52.1% (p = 0.015). The median duration of hospitalization was 6 days, with a low mortality rate of 2.2% (p = 0.741). CONCLUSION: The study demonstrates a significant incidence of appendicitis and other surgical emergencies in this population. We recommend early ultrasonography over plain radiography to improve diagnostic precision and prevent delays in pediatric surgical care in Somalia.