A challenging case of abdominal distension in a 3-year old child

Daniela Păcurar,Anca Angela Simionescu,Gabriela Leșanu,Cătălin Chiriac-Babei,Vlad Dima,Elena Roxana Smădeanu

doi:10.37897/rjmp.2021.s4.20

Abstract

Introduction. Important abdominal distension can be a challenge for both paediatricians and pediatric surgeons. Case presentation. Here, we report the case of a 3-year old child admitted to Pediatric Surgery Department for significant abdominal distension, food refusal and abdominal pain. He underwent radiological investigations; conditions like congenital megacolon and mechanical obstruction were excluded. At hospital admission, abdominal distension was minimal, but it became severe after episodes of air swallowing. Sleep bruxism and behavioural changes appeared also. An abdominal computerized tomography scan and barium swallow tests showed important distension of the stomach with excessive gas, a small intestine and colon. On upper endoscopy - the urease test for Helicobacter pylori detection was positive and specific treatment was administered. In addition, a psychiatric evaluation was done because of behaviour changes. Aerophagia was suspected, and clonazepam treatment was recommended. Conclusion. This is an unreported case of association between Helicobacter pylori infection and aerophagia, which had a favourable outcome after antibiotherapy for gastritis and clonazepam for psychologic aerophagia.

Highlights

INTRODUCTIONSignificant abdominal distension associated with abdominal pain can be a challenge for both paediatricians and pediatric surgeons
Important abdominal distension can be a challenge for both paediatricians and pediatric surgeons.Case presentation
Aerophagia is defined as a functional gastrointestinal disorder characterized by excessive and repetitive air swallowing, causing progressive abdominal distension [1]

Summary

INTRODUCTION

Significant abdominal distension associated with abdominal pain can be a challenge for both paediatricians and pediatric surgeons. Aerophagia is defined as a functional gastrointestinal disorder characterized by excessive and repetitive air swallowing, causing progressive abdominal distension [1]. Physical examination revealed a slightly malnourished and dehydrated boy, weighed 13 kg and heightened 95 cm (Z score BMI - 1.6 SD) His mother reported food refusal, abdominal pain and normal stools. Conditions like congenital megacolon and mechanical obstruction were excluded He was transferred five days later to Gastroenterology Department. Barium swallow radiology examination showed excessive gas in the stomach and intestine (Figure 1A,B). Several audible repetitive movements of air swallowing were observed, but his mother denied previously similar episodes. Abdominal distension was minimal in the morning, but after the episodes of air swallowing, it became more severe with a maximum in the late evening, and excessive flatus overnight was reported. Gaseous distension of the stomach, small intestine and colon, without evidence of obstruction 92

DISCUSSION

Findings

CONCLUSIONS