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Abstract: In pediatric outpatient and emergency departments，the initial symptoms of extraperitoneal critical illness with abdominal pain as the main complaint are often rather concealed，but they progress rapidly and are prone to misdiagnosis or missed diagnosis．This article reveals the concealment and high risk of several abdominal critical conditions in pediatrics by analyzing typical cases such as posterior cranial fossa tumors，pericardiotomy syndrome，fulminant myocarditis and diabetic ketoacidosis．The article proposes a systematic diagnosis and treatment mindset：detailed inquiry of medical history to capture atypical clues，comprehensive physical examination beyond abdominal assessment，and precise selection of auxiliary examinations．Early identification and multidisciplinary collaboration are the keys to improving prognosis，warning clinicians to broaden their diagnostic thinking and avoid missed diagnoses．

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