Abdominal Distension

A prominent “potbelly” contour is normal in infants and young children. Pathologic enlargement of the abdomen is a fairly common problem that can result from reduced tone of the wall musculature or from increased content (gas, liquid, or solid). Acute-onset abdominal distension is a sign that should be taken seriously, especially when accompanied by bilious vomiting.

Differential Diagnosis

• Mechanical intestinal obstruction
  –Incarcerated inguinal hernia
  –Malrotation with volvulus
  –Intestinal atresia (newborns)
  –Imperforate anus (newborns)
  –Intussuception
  –Hirschsprung disease
  –Meconium ileus (in newborns, due to CF)
  –Left microcolon syndrome (typically in infants of diabetic mothers)
  –Fecal impaction (from chronic constipation)
  –Bezoars: Lactobezoars in premature infants
• Functional intestinal obstruction
  –Paralytic ileus, postoperative ileus, reflex ileus (from sepsis or acute infection)
  –Peritonitis/intestinal perforation
  –Severe hypokalemia
  –Gastroparesis
  –Necrotizing enterocolitis (NEC)
  –Toxic megacolon (IBD)
  –Dysmotility (pseudo-obstruction syndrome)
• Renal enlargement
  –Hydronephrosis (most common cause of abdominal distension in the newborn)
  –Ureteropelvic junction obstruction
  –Bladder distension
  –Congenital polycystic kidney
• Ascites
• Hepatomegaly
  –Budd-Chiari or Beckwith-Wiedemann
  –Glycogen storage disease
  –Amyloidosis
  –Congestive heart failure
• Splenomegaly
• Tumors/cysts
  –Wilms tumor, neuroblastoma, lymphoma, teratoma, sarcoma, ovarian cyst or tumor, omental cyst, dermoid cyst
• Pancreatic pseudocyst
• Obesity: Protuberant abdomen (common)
• Aerophagia
• Pregnancy
• Hematometrocolpos
• Malnutrition (e.g., kwashiorkor, celiac)
• Abdominal abscess
• Prune-belly syndrome
• Poor posture

Workup and Diagnosis

• Rapid recognition of obstruction is essential
• History: Age of onset, duration, fever, weight loss, vomiting (bilious/nonbilious), abdominal pain, last bowel movement, bloody or currant-jelly stools (intussuception), last menstrual period, respiratory distress, trauma
• Birth history, PMH, PSH, time of passage of meconium (delayed in Hirschsprung)
• Maternal history: Pregnancy (oligo- or polyhydramnious), labor/delivery, gestational diabetes
• Physical exam: Vital signs, general appearance, abdominal exam for presence of ascites (flank bulging, shifting dullness, fluid wave), masses and tympanic percussion, umbilicus sunken in obesity, herniated if tense ascites, perineum exam for inguinal hernia
• Labs: CBC, Serum electrolytes, LFT, UA, stool for occult blood, amylase, and lipase
• Studies
  –Obstructive series for air fluid levels, distended bowel loops, or pneumoperitoneum
  –Abdominal ultrasound for pancreatic pseudocyst, ascites, and masses
  –Upper GI series for proximal obstruction
  –Barium enema for distal obstructions
  –CT scan of the abdomen for better delineation of masses or anatomical anomalies
  –Surgical consult if obstruction or perforation suspected

Treatment

• Treatment is focused on underlying cause
• Management of intestinal obstruction
  –Make the patient NPO
  –Nasogastric tube placement for decompression
  –Correction of fluid and electrolyte imbalance
  –Antibiotic for cases of suspected perforation, NEC, or peritonitis
  –Laparascopy/laparatomy: Prompt relief of obstructions or repair of perforation is paramount
• Prokinetic for dysmotility or gastroparesis
• Surgical resection and subsequent reanastomosis for Hirschsprung disease (one-step or staged repair)
• Percutaneous, surgical, or endoscopic drainage of pancreatic pseudocyst if persistent
• Fecal disimpaction and treatment of constipation
• Correction of malnutrition
• Contrast or air enema for reduction of intussuception or flushing of meconium ileus
• Surgical resection of tumor

Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

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Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

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• Back to symptom: Abdominal swelling: Introduction (review 508 causes)
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More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

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