Diarrhea Mild diarrhea with the onset of abdominal pain suggests acute gastroenteritis or early appendicitis. Delayed onset of diarrhea may indicate a perforated appendicitis, with the inflamed mass causing irritation of the sigmoid colon. The abdomen should be observed, auscultated, and palpated for distention, localized tenderness, masses, and peritonitis. The groin must be examined to exclude an incarcerated hernia or ovary, or torsion of an ovary or testicle. Rectal Examination Gross blood in the stool suggests ectopic gastric mucosa, Meckel's diverticula, or polyps.
Melena suggests upper gastrointestinal bleeding, necessitating gastric aspiration for blood.
Tests for occult blood in the stool should be performed. The rectal examination may also be used to evaluate the cervix, uterus, adnexa, and other pelvic masses. Costovertebral angle tenderness with fever suggests pyelonephritis or a high retrocecal appendicitis. Perforation often follows the onset of symptoms in 24-48 abdominal pain, stomach pain hours. This incidence declines as the age of the child increases.