Physiological versus Pathological Causes of Big Belly in Children
Having a big belly in children can be a common concern for parents, but it is important to differentiate between physiological and pathological causes. Physiological causes may include a child’s natural growth and development, especially during growth spurts. It can also be influenced by a child’s diet and exercise habits.
On the other hand, pathological causes of a big belly in children may indicate underlying health issues that need medical attention. These can include conditions such as abdominal tumors, organ enlargement, or gastrointestinal disorders. It is essential to consult a healthcare provider if a child’s big belly is accompanied by symptoms such as abdominal pain, bloating, or changes in appetite or weight.
An Unusual Case of a Toddler with a Big Belly: Abdominal Lymphatic Malformation
The case report of the 3-year-old girl with abdominal pain, bloating, and weight gain highlights the importance of considering rare conditions such as lymphatic malformations in pediatric patients. While these malformations are typically found in the neck and armpits, they can also occur in the gastrointestinal tract, as seen in this case.
Early recognition and diagnosis of abdominal lymphatic malformations are crucial for proper management and treatment. Surgical removal, as in this case, may be necessary to alleviate symptoms and prevent complications. This case serves as a reminder for healthcare providers to consider unusual causes of abdominal symptoms in young patients.
Keywords: Pediatric abdominal pain; pediatric emergency department (PED); lymphatic malformation; case report
Received: 02 October 2020; Accepted: 24 January 2021; Published: 25 July 2021.
Introduction
Abdominal pain in children is a common issue in the pediatric emergency department due to the various possible diagnoses and diagnostic challenges, particularly in young kids. We describe a case of a child with abdominal pain, weight gain, and bloating leading to the identification of a lymphatic malformation requiring surgery.
Case presentation
A 3-year-old girl presented to the PED with complaints of abdominal pain, low-grade fever, and reduced appetite. Upon examination, a distended abdomen was noted, and imaging revealed significant abdominal fluid accumulation. Further tests confirmed a diagnosis of lymphatic malformation. The patient underwent surgery, resulting in symptom improvement.
Discussion
This case report outlines the presentation, assessment, treatment, and diagnosis of a child with a rare abdominal lymphatic malformation. The challenges and constraints in follow-up care are discussed, emphasizing the importance of considering congenital anomalies in cases of pediatric abdominal pain.
The exact cause of lymphatic malformations remains unclear, with theories proposing early lymphatic vessel sequestration leading to cyst development. Additionally, inflammatory processes may contribute to cyst formation.
Ultrasonography is essential for initial diagnosis, detecting intracystic septae. CT scans depict cystic structures and are readily available in emergency settings. MRI is preferred for extensive malformations and hemorrhagic complications.
There is limited literature on congenital lymphatic malformations, particularly in toddlers. Diagnosis can be challenging due to limited speech development. Post-surgical surveillance is best conducted using ultrasonography, with surgical excision as the definitive treatment.
Children with abdominal pain and distention should undergo imaging studies for evaluation. Lymphatic malformations can manifest in different body areas, posing a diagnostic challenge but should be considered when assessing masses.
I would like to express my gratitude to the following individuals for their contributions to this article:
– [Name]: for providing insightful feedback and suggestions.
– [Name]: for assistance with data analysis.
– [Name]: for guidance and support throughout the writing process.
Thank you all for your valuable input and support.
Footnote
Reporting Checklist: The author has completed the CARE reporting checklist. Available at http://dx.doi.org/10.21037/jeccm-20-146
Conflicts of Interest: The author has completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jeccm-20-146). The author declares no conflicts of interest.
Ethical Statement: The author is responsible for ensuring the accuracy and integrity of the work. All procedures involving human participants followed ethical standards. Written informed consent was obtained.
Open Access Statement: This is an Open Access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0).
Additional Information: For further inquiries, please contact the author at [author’s email address].
References
- Reust CE, Williams A. Acute Abdominal Pain in Children. Am Fam Physician 2016;93:830-6. [PubMed]
- Rana A, Katzman PJ, Pegoli W, et al. An unusual cause of abdominal pain: duodenal cystic lymphangioma. Gastroenterol Hepatol (N Y) 2013;9:192-5. [PubMed]
- Francavilla ML, White CL, Oliveri B, et al. Intraabdominal Lymphatic Malformations: Pearls and Pitfalls of Diagnosis and Differential Diagnoses in Pediatric Patients. AJR Am J Roentgenol 2017;208:637-49. [Crossref] [PubMed]
- Calmés D, Médart L. Abdominal Lymphatic Malformation. J Belg Soc Radiol 2018;102:57. [Crossref]
- Chateil JF, Brun M, Vergnes P, et al. Abdominal cystic lymphangiomas in children: presurgical evaluation with imaging. Eur J Pediatr Surg 2002;12:13-8. [Crossref] [PubMed]
- Iyer R, Eftekhari F, Varma D, et al. Cystic retroperitoneal lymphangioma: CT, ultrasound and MR findings. Pediatr Radiol 1993;23:305-6. [Crossref] [PubMed]
- Steyaert H, Guitard J, Moscovici J, et al. Abdominal cystic lymphangioma in children: benign lesions that can have a proliferative course. J Pediatr Surg 1996;31:677-80. [Crossref] [PubMed]
doi: 10.21037/jeccm-20-146
Cite this article as: Riney LC. An unusual cause of a toddler with a big belly, abdominal lymphatic malformation case report. J Emerg Crit Care Med 2021;5:24.
1. What is a big belly?
A big belly in infants can be a normal occurrence or indicate digestive issues. Parents should pay attention to signs of a big belly in babies and take appropriate steps.
2. When is a big belly physiological?
The definition of a big belly in children is not precise and may refer to increased abdominal size, changes in circumference, or the abdomen protruding higher than the sternum in newborns.
A big belly in children may stem from normal causes or be linked to digestive problems.
Physiological causes of a big belly in children may include:
- Rapid growth spurts
- Excess gas accumulation
- Consumption of high-fiber foods
It is important to consult with a healthcare provider if you have concerns about your child’s belly size to determine the underlying cause and appropriate course of action.
3. How to recognize a big belly in children is due to physiology
A big belly in infants due to natural reasons is characterized by regular digestive processes. Stool appearance differs between breastfed and formula-fed babies, but if the child shows no abnormal symptoms, parents should not be concerned.
4. When is a big belly due to a disease?
Sometimes, a big belly in children may indicate a digestive disorder. Parents should watch for recurrent nausea and a firm abdomen, seeking medical advice if necessary.
2.1 Due to the child being full
In young children, especially newborns, a big belly after feeding is often normal. The protrusion of the abdomen may be due to underdeveloped abdominal muscles.
2.2 Due to the child’s intestinal structure being too large compared to the body
If the cause is physiological, parents should not worry as the child’s growth will eventually normalize the size of the abdomen.
4.1 Are there additional digestive symptoms?
Repeated nausea might signal a metabolic issue requiring medical assessment.
A firm, distended abdomen may require immediate attention, while a soft abdomen with bowel sounds is typically harmless.
4.2 Are there associated systemic symptoms?
Abdominal distension accompanied by other symptoms like tachycardia, tachypnea, or unstable body temperature could indicate an infection. Evaluation should include testing for infection and further examination of the gastrointestinal system.
If a baby experiences a lack of bowel movements, consider constipation. For infants who have never passed stool and are a few days old, intestinal obstruction should be considered. Check stool quality and the presence of blood for recent stools.
Possible conditions in a child with a large belly may include bloating, indigestion, or megacolon in newborns. Other causes could be food allergies, Hirschsprung’s disease, or tumors. A big belly in a child, especially under 6 months old, is often normal. However, seek medical attention promptly if there are abnormal signs.
Contact the HOTLINE for more details or schedule an appointment HERE. Download the MyVinmec app for quick appointments and easy booking management.