SHM Converge Scientific Abstract ePoster Gallery-Diagnostic Misdirection: A Common Pediatric Complaint Concealing an Unexpected Finding

Pdf Summary

A 14-year-old girl with trisomy 21, hypothyroidism, chronic constipation, and recurrent otitis media developed progressive abdominal distension over 2 to 3 months. Because of her constipation history, she was initially evaluated for fecal impaction and underwent flexible sigmoidoscopy and bowel cleanout. However, no impaction was found. An abdominal x-ray then showed a mass-like density, leading to MRI, which demonstrated a 20 cm cystic right ovarian mass with a lobulated solid component, chronic torsion features, and mass effect on surrounding structures.<br /><br />Laboratory testing showed a mildly elevated CA-125, with other tumor markers and routine labs largely normal. She subsequently underwent exploratory laparotomy and right salpingo-oophorectomy. Pathology revealed stage IA mucinous adenocarcinoma of the ovary.<br /><br />This case highlights the risk of diagnostic anchoring on common pediatric complaints such as constipation, especially in patients with developmental delay who may have limited history-taking. It emphasizes the need to reassess when symptoms do not fit the expected course and to maintain a broad differential diagnosis for pediatric abdominal distension. Although mucinous ovarian carcinoma is rare, it can present as a large mass and is often diagnosed at an early stage; timely recognition is important because outcomes are much better in stage I disease than in advanced stages. The patient was referred to gynecologic oncology for surveillance.

Asset Subtitle

Diane Hassanieh

Meta Tag

Author List David Fish, Diane Hassanieh, Wael N. Sayej

Category Clinical Vignettes

Concept Abdominal Distension

Concept Differential Diagnosis

Concept Abdominal Mass

Concept Mucinous Ovarian Adenocarcinoma

Concept Pediatric Abdominal Complaint

Distinguished Non-Finalist

Presenter Organization Baystate Medical Center

Presenting Author Diane Hassanieh

Track Pediatric

Keywords

trisomy 21

pediatric abdominal distension

mucinous ovarian adenocarcinoma

ovarian mass

chronic constipation

diagnostic anchoring

MRI imaging

CA-125

salpingo-oophorectomy

stage IA cancer

Abdominal Distension

Differential Diagnosis

Abdominal Mass

Mucinous Ovarian Adenocarcinoma

Pediatric Abdominal Complaint