An abdominal mass in an infant or child has a long differential diagnosis and includes a spectrum of conditions. These conditions range from those that are benign and self-resolving to those that are life threatening and require urgent intervention. These illnesses involve the many organ systems contained in the abdominal cavity, and the pathophysiology of each disease is diverse.

The etiology of some bulges is related to normal processes that occur during fetal development that fail to complete. For example, omphaloceles and gastroschisis can result from the normal process of gastrointestinal development that begins outside the fetus and then reenters the abdomen. Urachal cysts are remnants of the allantois that forms the umbilicus in fetal development. Diastasis recti and umbilical hernias are due to failure of abdominal wall musculature to fully close. In the majority of cases, these midline bulges resolve spontaneously.

• Diastasis recti is common in newborns.

• Umbilical hernias are more prevalent in preterm (up to 75% of <1,500 g birth weight) and African American infants (20% vs 3% of Caucasian neonates).

• Omphaloceles are often associated with chromosomal disorders, including trisomy 13, 18, and 21, and with Beckwith–Wiedemann syndrome, whereas gastroschisis often occurs in isolation.

• Hypertrophic pyloric stenosis presents at about 2 to 6 weeks of life with projectile nonbilious vomiting.

• Persistent urachus and other urachal anomalies can present with a persistently draining umbilical cord.

• About 1% to 2% of patients have a positive family history in patients with Wilms tumor.

• Diastasis recti presents as a midline, vertical ridge that can extend between the xiphoid process and the umbilicus, when an infant cries.

• An epigastric hernia is often located in the middle abdomen above the umbilicus and may occur in multiples.

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