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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摘要： 儿科门急诊中以腹痛为主诉的腹外危重症初期症状常比较隐匿，但进展迅猛，易误诊或漏诊。文章通过解析后颅窝肿瘤、心包切开综合征、暴发性心肌炎及糖尿病酮症酸中毒等典型病例，揭示了儿科几种腹外危重症的隐匿性与高危险性。文章提出系统化诊疗思维：详询病史以捕捉非典型线索，进行全面体格检查超越腹部评估，并精准选择辅助检查。早期识别与多学科协作是改善预后的关键，警示临床医生拓宽诊断思路，避免漏诊。

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