right or left lower abdominal tenderness is present on physical examination to evaluate for ovarian torsion and tubo-ovarian abscess A pelvic examination is required in any sexually active female with abdominal pain Cervical discharge or tenderness suggests the diagnosis of PID Appropriate cultures and microscopic examinations for sexually transmitted infections are indicated and presumptive antimicrobial treatment should be initiated Other, nongynecologic etiologies of abdominal pain, including appendicitis, must also be considered Chronic or recurrent abdominal pain may be due to dysmenorrhea or endometriosis Laparoscopy may be required to confirm the diagnosis SUMMARY Abdominal pain is one of the most common complaints among children seeking care in the ED An algorithmic approach to the child with acute abdominal pain should be performed, with a focus on traumatic and surgical conditions Generation of a differential diagnosis should take into consideration the age of the child When evaluating a child with abdominal pain, the first priority should be the stabilization of the seriously ill or injured child The next priority is to identify the child who requires immediate or potential surgical intervention, whether for a traumatic injury, appendicitis, intussusception, or other congenital conditions Finally, a thorough examination should be conducted to determine the etiology of abdominal pain Laboratory evaluations and radiographic studies may be used selectively to support or refute specific differential diagnoses generated by the history and physical examination Suggested Readings and Key References Bachur RG, Dayan PS, Bajaj L, et al The effect of abdominal pain duration on the accuracy of diagnostic imaging for pediatric appendicitis Ann Emerg Med 2012;60:582–590 Bundy DG, Byerley JS, Liles EA, et al Does this child have appendicitis? JAMA 2007;298:438–451 Chogle A, Mintjens S, Saps M Pediatric IBS: an overview on pathophysiology, diagnosis and treatment Pediatric Ann 2014;43:e76–e82 Fox JC, Boysen M, Gharahbaghian L, et al Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma Acad Emerg Med 2011;18:477–482