Intermittent Abdominal Distension Research Articles

Meconium pseudocyst without radiological calcification

Introduction: Meconium peritonitis is a rare disease which can be potentially fatal. Case Report: We present the history of a full-term male infant born at 2945 g via lower segment cesarean section (LSCS). There was an antenatal diagnosis of an intra-abdominal cyst. At 27+6 weeks gestation, the ultrasound scan noted a thick-walled cystic mass superior to the bladder. Postnatally, an X-ray showed a paucity of gas in the right lower quadrant and an ultrasound scan confirmed a large central avascular cystic lesion, with posterior sediments noted. Laparotomy revealed extensive adhesions surrounding a meconium filled cyst. This was excised and a primary anastomosis performed. However, he failed to progress with feeds, having intermittent abdominal distension, and after a contrast study on day 18 post op which showed failure of contrast to pass the dilated proximal jejunum, he was taken back to the operating room and was found to have significant adhesions. Adhesiolysis was done and the anastomosis was patent and well healed. However, these episodes of abdominal distension continued, and he never progressed with feeds. On day 39 of life, there was severe metabolic acidosis refractory to resuscitation, leading to cardiac arrest. Conclusion: There can be subtle presentations of meconium peritonitis in the newborn and it should be considered in any neonate with an intra-abdominal cyst.

Intestinal obstruction due to annular pancreas in neonatal period: a case report

Annular pancreas is a rare congenital malformation characterized by a pancreatic ring surrounding the descending part of the duodenum. It occurs in 1:20,000 live births. The age of presentation depends on the severity of the intestinal obstruction. The diagnosis requires imaging studies and surgical exploration. This is the case of a 13-day-old newborn admitted to the Neonatal Intensive Care Unit of Hospital Nacional Arzobispo Loayza. He presented with gastric residuum, vomiting and intermittent abdominal distension. Given the persistent gastrointestinal symptoms despite the treatment administered, a radiological examination of the upper digestive tract with contrast dye was conducted. Signs of duodenal stenosis were found. An exploratory laparotomy showed a postoperative diagnosis of annular pancreas. Kimura’s diamond-shaped side-to-side duodenoduodenal anastomosis was performed as a definitive treatment.

Pancreatic pseudocyst after pegaspargase treatment in six children

Objective: To investigate the clinical characteristics and treatment of pancreatic pseudocyst after pegaspargase treatment in children. Methods: The clinical data of 6 children with pancreatic pseudocyst after pegaspargase treatment in the Department of Pediatrics in Peking University Third Hospital from July 2018 to February 2021 were analyzed retrospectively. Results: There were 4 males and 2 females, and their age of onset was 9.5 (5.8, 13.0) years. The total number of pegaspargase applications was 2.5 (2.0, 3.5) times. The course from the last dose of pegaspargase to the onset of pancreatitis was 11.0 (9.0, 17.2) days, and 42.5 (35.0, 129.5) days from the onset of pancreatitis to the diagnosis of pancreatic pseudocyst. Abdominal pain was the most prominent manifestation of pancreatitis (6/6). All of the 6 children were asymptomatic when pancreatic pseudocyst was noted, and were treated conservatively at first, but one case later developed intermittent abdominal distension or nausea after eating. All the cases had pancreatic pseudocyst enlargement during the conservative treatment. Three children were treated with endoscopic ultrasound-guided transgastric drainage, and the cyst disappeared from 10 days to 4 months after the operation. The other 3 children received endoscopic retrograde cholangiopancreatography (ERCP)-guided transpapillary drainage, but one of them turned to surgery due to pancreatic duct stricture, and in the rest 2 children the cyst disappeared at 1 and 3 months after operation respectively. Regarding safety issues, 1 child who received ERCP-guided transpapillary drainage had acute postoperative pancreatitis, which were improved after treatment, and the other 5 had no complications. Conclusions: Pancreatic pseudocyst after pegaspargase chemotherapy can be asymptomatic in the early stage, and should be diagnosed with a history of pegaspargase treatment and timely imaging examination. Conservative treatment is the first choice for asymptomatic pseudocyst. When the pseudocyst enlarges, different endoscopic drainage treatments are required according to whether the pseudocyst is connected with the main pancreatic duct.

Fatty abdominal aortic aneurysm.

This is a rare fatty abdominal aortic aneurysm (AAA) in a man in his 52s (Panels A–D). The patient presented with a 1 year history of pulsatile mass and intermittent abdominal distension. He had a 5-year medical history of hypertension which was well controlled by daily Irbesartan therapy (75 mg, po, qd). Examination revealed one pulsatile mass was touchable in the middle quadrant. The D-dimer test result was 8.32 mg/L (normal <0.5). An abdominal ultrasound Doppler showed that the infrarenal aorta was dilated to as big as 67 × 59 mm accompanying with hypoechoic attachment in the inner side of the dilated aorta. Next, a routine aortic computed tomographic angiography (CTA) was performed, and CTA determined this pulsatile mass as AAA. We admitted his presumed diagnosis as AAA with intraluminal thrombus (ILT). Considering his therapeutic willingness, we performed an open surgery for this patient. However, after dissection of the AAA mass, we found plenty of lipoid lesions in the vessel wall—with no evidence of ILT (Panels E–H). Postoperative histological and dual energy computed tomography (CT) scan analysis presented that there was extensive oil red (+) staining in the vessel wall (Panels I–Q).

Gas-filled urachal abscess with a pinging sound in a heifer calf

A 6-month-old crossbred of a Holstein and Japanese Black heifer calf weighing 95 kg presented with a history of intermittent abdominal distension and failure to thrive. The physical examination identified a pinging sound over the dorsal left flank. The abdominal radiography showed a huge gas-filled mass. The intravenous urography revealed no communication between the mass and the urinary bladder. Although the visual examination and palpation of the umbilicus did not reveal visible abnormalities, an umbilical disease was suspected because the animal exhibited poor growth, depression, and a hunched back posture. When the eschar adhering to the centre of the umbilicus was removed, the presence of a fistulous tract was revealed. The umbilical ultrasound examination revealed an intra-abdominal abscess and the fistulography demonstrated that the abscess communicated with the umbilicus. The abscess, compressing into the rumen, was observed by computed tomography. From these images, it was diagnosed as an umbilical cord remnant abscess and a definitive diagnosis of a urachal abscess was obtained by open abdominal surgery and the subsequent removal of the mass. The calf was discharged from the university hospital on day 14 after the operation. This case shows that a urachal abscess should be considered when a pinging sound is present, even if the animal exhibits no swelling or pain of the umbilicus.

Intermittent abdominal distension as a form of presentation of chronic gastric volvulus

Intermittent abdominal distension as a form of presentation of chronic gastric volvulus

Index of Suspicion

* ALT: : alanine aminotransferase AST: : aspartate aminotransferase BUN: : blood urea nitrogen CBC: : complete blood count CNS: : central nervous system CSF: : cerebrospinal fluid CT: : computed tomography ECG: : electrocardiography ED: : emergency department EEG: : electroencephalography ESR: : erythrocyte sedimentation rate GI: : gastrointestinal GU: : genitourinary Hct: : hematocrit Hgb: : hemoglobin MRI: : magnetic resonance imaging WBC: : white blood cell An 11-year-old boy presents to the emergency department with a 1-week history of frequent episodes of nonbloody, nonbilious emesis associated with diarrhea and abdominal cramping. He has urgency and fecal incontinence. He has been afebrile and denies any rashes, joint pain, sick contacts, headaches, or other symptoms. On further questioning, his mother reveals that he has had 2 similar episodes of abdominal distension and diarrhea during the past 6 to 7 years. Between these episodes, she states that he normally has nonbloody, hard stools accompanied by straining and chronic abdominal pain and pain with defecation. When asked specifically, his mother does not remember when he passed his first stool after he was born. On physical examination, his temperature is 37.6°C, pulse is 100 beats per minute, respiratory rate is 16 breaths per minute, blood pressure is 113/62 mm Hg, oxygen saturation is 100% on room air, height is 63 inches (95%), and weight is 36.7 kg (25%). He has abdominal distention and diffuse abdominal tenderness with voluntary guarding. There is palpable stool in the left quadrant. There is no perianal erythema or skin tag, and rectal examination reveals a low anal tone. A CT scan of the abdomen (Figure 1) reveals a markedly distended rectosigmoid colon with circumferential, confluent, and contiguous mural thickening. Basic metabolic profile, CBC, and urinalysis results are unremarkable, but the C-reactive protein level is elevated at 131 mg/L (1248 nmol/L). Because of the concern for enterocolitis, he is empirically given broad-spectrum intravenous antibiotics and transferred to a children’s hospital for further evaluation. Figure 1. A CT scan of the abdomen shows a markedly distended rectosigmoid colon with circumferential mural thickening. A 4-year-old boy presents for evaluation of intermittent fevers of 4 weeks’ duration after 2 separate antibiotic courses prescribed for acute otitis media. He has experienced clear rhinorrhea and …

Gastrointestinal: Mesenteric cystic lymphangioma

The patient illustrated below was a woman, aged 49 years, who was investigated because of a 2 month history of abdominal pain and intermittent abdominal distension. She had a past history of ovarian surgery for benign lesions. A pelvic ultrasound study was consistent with cystic enlargement of both ovaries. At laparoscopy, both ovaries were normal but there was a large mass in the lower abdomen. At laparotomy, the mass was 15 cm in diameter, off-white in color and was arising from the root of the mesentery, 60 cm from the duodenal-jejunal junction (Fig. 1). The tumor was adherent to the small bowel and was resected along with an adjacent segment of jejunum. On sectioning, copious amounts of thick milky fluid were expressed from the specimen. Histological evaluation revealed dilated lymphatics lined by attenuated endothelial cells, typical of a cystic lymphangioma (Fig. 2). She remains well 1 year after surgery. Mesenteric lymphangiomas are uncommon lesions with a female predominance. Frequencies of between 1 in 20 000 and 1 in 250 000 hospital admissions have been reported. The mean age at diagnosis is between 5 and 10 years and only a minority of patients are diagnosed as adults. Most lymphangiomas are thought to be developmental malformations early in life rather than true neoplasms. Presenting symptoms are often non-specific but include nausea, vomiting, abdominal distension and abdominal pain. Occasionally, patients present acutely with intestinal obstruction, volvulus, intra-abdominal bleeding or traumatic rupture. Acute presentations are more common in children than in adults. On imaging, the differential diagnosis can include pancreatic pseudocysts, cystic mesotheliomas, ovarian cysts and perhaps cystic teratomas. Treatment is surgical with resection of the mass, sometimes including resection of adjacent bowel. After surgery, recurrence rates are low and are usually the result of incomplete excision.

Rectus muscle diastasis in males: primary indication for endoscopically assisted abdominoplasty.

Endoscopic techniques through umbilical and mons pubis ports have provided a method to plicate rectus muscle diastasis without skin resection. Limited or no skin excision is performed. Major series have included only women. The criteria for patient selection for endoscopic abdominoplasty include a protuberant abdomen caused by rectus muscle diastasis with minimal actual or potential skin laxity. There should not be significant intra-abdominal obesity. Extra-abdominal familial fat deposits may be part of the abdominal aesthetic deformity. In most women, rectus muscle diastasis because of pregnancy, obesity, or aging is associated with actual or potential skin laxity of the abdomen and lateral trunk. Endoscopic abdominoplasty in these women would produce mediocre early results and poor aging potential for the future. There are a limited number of women who are reasonable candidates for the endoscopic approach. In contrast, rectus muscle diastasis without skin laxity is a common finding in men older than 30 to 40 years of age. There may be a history of weight fluctuations, weightlifting, or full-excursion sit-up exercises, which may lead to progressive separation of the rectus muscles over time. Other etiologic factors include chronic or intermittent abdominal distension, advancing age, or familial weakness of the abdominal musculofascial tissues. Endoscopically assisted abdominoplasty was performed in four male patients with good to excellent results at 4 to 18 months. Minor complications occurred in half the patients but were successfully treated without re-operation. Men with prominent abdominal contours who are diet- and exercise-resistant should be examined both for familial fat deposits and for significant rectus muscle diastasis. Contouring of the male abdomen may be the primary indication for endoscopically assisted abdominoplasty.

ABDOMINAL DISTENSION IN INFANTS ON PHOTOTHERAPY

We noted that infants undergoing phototherapy (Phx) often develop abdominal distension, and thus undertook a study to evaluate possible mechanisms for this distension. 20 infants on continuous Phx with standard methods of eye occlusion were compared with two control groups - jaundiced infants not on Phx, and healthy non-jaundiced infants. The abdominal circumference was measured prior to feeding. Treated infants exhibited an increase in abdominal circumference ranging from 1-4 cm (mean 2.5) compared with 0-1 cm (mean 0.5) in each of the two control groups; distension was noted within 8-12 hours, reaching a maximum by ca 24 hours.In 4 infants intermittent Phx with intermittent eye occlusion (16 hrs. on, 8 hrs. off) resulted in intermittent abdominal distension during light periods, with a mean increase in circumference of 1.9 cm. In 15 additional infants in whom eye occlusion (and Phx) was discontinued during all feeding periods and re-applied after feeding, abdominal distension still developed (1-3 cm, mean 2.3).Preliminary studies were performed in which infants on Phx did not have their eyes occluded but had their faces shielded by a black screen; abdominal distension did not develop. Subsequent eye occlusion did produce abdominal distension, suggesting that the distension was the result of eye occlusion rather than the direct result of Phx. These findings may be significant in evaluating other sequelae of Phx, e.g. behavioral changes.

CHRONIC DYSPEPSIA IN CHILDREN OF SCHOOL AGE

The term u chronic dyspepsia in children is used to connote a group of symptoms, varying in degree and in proportion, which together form a common clinical picture. For the most part it arouses no memory of exact morbid anatomy or of precise deviations from the normal in functional activity. The picture presented to our minds is somewhat as follows. The child is ailing, dull, and listless, lacking vitality and composure. The appetite is poor and capricious, the tongue coated, and the breath heavy and perhaps foul. The complexion is muddy, wrhile the faci?s, with sunken eyes, or puffy eyelids and dark orbital rings, is itself characteristic enough to suggest the nature of the malady. There may be abdominal pains of varying degrees of severity, from slight discomfort to attacks of colic; or pain may be absent. The pain may occur after food, but is seldom gastric in position, being more often about the umbilicus or along the course of the large intestine. It may be related to the passage of flatus or precede defaecation. The general nutrition is usually im paired,, the child losing weight in severer forms, failing to gain weight in milder. On the other hand, the weight may be satisfactory but there is a general tonelessness of skin and muscles. The stools are variable, in some cases in frequent, in others too frequ?pt, but always irregular. They may be uneven in their consistence, particoloured, offensive, and contain mucus or even blood, and food which has not been digested. There may be slight nocturnal fever, perhaps with bouts of higher fever, coincidently with which the odour of the breath and the abdominal symptoms become more evident. Sleep is restless, often disturbed by dreams or night terrors. In some cases there is wakefill ness. In the morning the child is tired and drowrsy, and dislikes getting up. During the day he is easily exhausted and fatigued, liable to headaches, and lacks concentration or interest in his school work, being slow in acquisition and poor in performance. Psychical symptoms take an im portant place, but are more prominent in some cases than in others, depending in their degree, in part at least, on hereditary psychical traits. The child is apt to be morose, despondent, resistant, and irritable, solitary in habit, taking no part in games, and subject to fits of crying and of temper. Examination of the abdomen may reveal no abnormal physical signs, or there may be some persistent or intermittent abdominal distension, related chiefly to flatu lent distension, but in some cases in part to faecal accumu lation* There may be considerable indicanuria.