Important abdominal distension associated with abdominal pain can be a challenge for both paediatrician and paediatric surgeon. Several conditions, primarily surgical conditions, but also medical ones must be considered.Objective
We report case of a 3 year old child who was admitted in our Paediatric Surgery Departement for important abdominal distension, food refusal, abdominal pain and consecutive dehydration.Method
The child underwent radiological investigations in the Paediatric Surgery Department and conditions like congenital megacolon and mechanical obstruction were excluded. He was transferred five days later to our Paediatric Clinic. Initially iv fluids were administred, but considering the persistent food refusal parenteral nutrition was instituted. Five days later enteral nutrition was started through a nasogastric tube. Concomitant with the investigations needed to exclude, celiac disease, thyroid function diseases, infections food intolerances, audible repetitive movements of air swallowing were observed, sparse at the beginning but after a few days they appeared more often. In the first half an hour after waking up, the child had a slender abdomen but after the episodes of air swallowing appeared his abdomen became increasingly distended. The symptoms persisted and were associated with sleep bruxism and changes in behaviour. A head and abdomen CT and a barium swallow were performed; diffuse and severe gas distension, attaining stomach, small intestine and colon was observed. On upper endoscopy – the urease test for Helicobacter pylori (Hp) detection was positive and specific treatment was administered. Considering the behaviour changes, a psychiatric evaluation was done and clonazepam treatment, was recommended.Conclusion
To our knowledge this is the first reported case of association between Hp infection and aerophagia which had a good evolution under specific Hp treatment and clonazepam.