Abdominal Distension in a Female Toddler

Presentation

A 3-year-old girl presents to the hospital due to concern that her abdomen seems “large and firm.” Her mother reports that the patient’s abdomen has always been “big” but was also always soft until the day before presentation, prompting mother’s acute concern.

The patient is otherwise healthy aside from 1 to 2 episodes of nonbloody, nonbilious emesis a few days before presentation. She has had ∼2 lb of “intentional” weight loss over the past year via improved diet and activity. She has remained afebrile without recent cough, congestion, rhinorrhea, shortness of breath, diarrhea, constipation, sweating, bruising, or easy bleeding. According to her mother, at no time has she complained of abdominal pain. A complete review of systems is otherwise negative. Interestingly, our patient’s mother reports a diagnosis of “teratoma” in herself when she was in her 30s.

On examination, the patient is well-appearing with vital signs appropriate for her age. Her weight is 27.1 kg (>99th percentile), height is 108 cm (98th percentile), and BMI is 23.2 (>99th percentile, Z = 3.14). No historical growth parameters are available. Her abdomen is grossly distended (Fig 1) and dull to percussion without tenderness to palpation, guarding, or rebound tenderness. There is no evidence of organomegaly, though liver and spleen are difficult to appreciate due to abdominal distension. Cardiopulmonary, skin, and neurologic examinations are unremarkable, and there is no detectable lymphadenopathy in the cervical, axillary, or inguinal regions.

Laboratory tests include a complete metabolic panel that is within normal limits, and urinalysis shows no evidence of infection or renal dysfunction. Supplemental laboratory values targeting elements of our differential …