ILLUSTRATIVE CASE
Omental Liposarcoma Presenting as Chronic Constipation Jimmy L. Hightower, Jr, MPAS, PA-C, DSc* and Daniel J. Dire, MD, FACEP, FAAP, FAAEMÞ Abstract: Constipation is a common cause of pediatric abdominal pain seen in pediatric emergency departments (EDs). We present the case of an 11-year-old boy with a 4-month history of chronic constipation and abdominal pain who presented to the children’s ED. He was found to have a large abdominal mass that was determined to be a myxoid liposarcoma. An extensive review of the medical literature did not reveal any previous cases of this type of tumor presenting to the ED as chronic constipation. Key Words: constipation, liposarcoma, abdominal pain, abdominal mass, omentum (Pediatr Emer Care 2014;30: 483Y484)
CASE An 11-year-old boy presented to the children’s hospital emergency department (ED) for acute exacerbation of abdominal pain. His parents related a 4- to 5-month history of intermittent diffuse abdominal pain and constipation for which the patient had been seen multiple times by his pediatrician. He was prescribed various laxative including polyethylene glycol and a high-fiber diet. His symptoms would wax and wane on a daily basis but would improve after having bowel movements. Intervals between stools were 3 or more days, usually initiated with laxatives or an enema. He experienced significant abdominal pain just before presentation and was unable to walk to school. He denied nausea, vomiting, and melena or hematochezia. The patient had a medical history significant only for mild persistent asthma that was well controlled with albuterol. His surgical history was negative, and he had no previous hospitalizations. There was no family history of neoplasms. Review of systems was negative for weight loss, bruising, fevers, lethargy, or other constitutional symptoms. He denied any urinary symptoms. There was no history of social or school problems. On examination, the patient was a thin but healthy-appearing young boy sitting in bed in no distress. His weight was 35 kg, and his vital signs were normal. HEENT (head, eyes, ears, nose & throat) exam revealed no scleral icterus, cervical masses, or adenopathy. His chest was clear to auscultation, and his cardiac examination was normal. His abdomen was moderately and uniformly distended, mildly tender with diffuse palpable ‘‘fullness’’ that was initially felt to be fecal matter, and there was no evidence of ascites. There was no adenopathy identified. His genitourinary examination was normal, and there were no inguinal hernias. A digital rectal examination was not performed. His extremities were nontender and well perfused without bruising or petechiae. Pertinent laboratory values included white blood cell count of 13, 200/KL and hemoglobin of 12.8 g/dL. His chemistries From the *Department of Emergency Medicine, The San Antonio Uniformed Services Health Education Consortium; and †Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX. Disclosure: The authors declare no conflict of interest. Reprints: Daniel J. Dire, MD, FACEP, FAAP, FAAEM, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Health Science Center, 7703 Floyd Curl Dr, MSC 7802, San Antonio, TX 78229 (e
Omental Liposarcoma Presenting as Chronic Constipation Jimmy L. Hightower, Jr, MPAS, PA-C, DSc* and Daniel J. Dire, MD, FACEP, FAAP, FAAEMÞ Abstract: Constipation is a common cause of pediatric abdominal pain seen in pediatric emergency departments (EDs). We present the case of an 11-year-old boy with a 4-month history of chronic constipation and abdominal pain who presented to the children’s ED. He was found to have a large abdominal mass that was determined to be a myxoid liposarcoma. An extensive review of the medical literature did not reveal any previous cases of this type of tumor presenting to the ED as chronic constipation. Key Words: constipation, liposarcoma, abdominal pain, abdominal mass, omentum (Pediatr Emer Care 2014;30: 483Y484)
CASE An 11-year-old boy presented to the children’s hospital emergency department (ED) for acute exacerbation of abdominal pain. His parents related a 4- to 5-month history of intermittent diffuse abdominal pain and constipation for which the patient had been seen multiple times by his pediatrician. He was prescribed various laxative including polyethylene glycol and a high-fiber diet. His symptoms would wax and wane on a daily basis but would improve after having bowel movements. Intervals between stools were 3 or more days, usually initiated with laxatives or an enema. He experienced significant abdominal pain just before presentation and was unable to walk to school. He denied nausea, vomiting, and melena or hematochezia. The patient had a medical history significant only for mild persistent asthma that was well controlled with albuterol. His surgical history was negative, and he had no previous hospitalizations. There was no family history of neoplasms. Review of systems was negative for weight loss, bruising, fevers, lethargy, or other constitutional symptoms. He denied any urinary symptoms. There was no history of social or school problems. On examination, the patient was a thin but healthy-appearing young boy sitting in bed in no distress. His weight was 35 kg, and his vital signs were normal. HEENT (head, eyes, ears, nose & throat) exam revealed no scleral icterus, cervical masses, or adenopathy. His chest was clear to auscultation, and his cardiac examination was normal. His abdomen was moderately and uniformly distended, mildly tender with diffuse palpable ‘‘fullness’’ that was initially felt to be fecal matter, and there was no evidence of ascites. There was no adenopathy identified. His genitourinary examination was normal, and there were no inguinal hernias. A digital rectal examination was not performed. His extremities were nontender and well perfused without bruising or petechiae. Pertinent laboratory values included white blood cell count of 13, 200/KL and hemoglobin of 12.8 g/dL. His chemistries From the *Department of Emergency Medicine, The San Antonio Uniformed Services Health Education Consortium; and †Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Health Science Center, San Antonio, TX. Disclosure: The authors declare no conflict of interest. Reprints: Daniel J. Dire, MD, FACEP, FAAP, FAAEM, Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Texas Health Science Center, 7703 Floyd Curl Dr, MSC 7802, San Antonio, TX 78229 (e
