CASE REPORTS ABSTRACT We report the case of a previously healthy 2-year-old child who presented with significant abdominal distension. After several interventions that proved ineffective, pathologic aerophagia was eventually diagnosed. In pediatrics, patho- logic aerophagia is an uncommon disorder that almost exclusively affects children with an underlying neurolog- ical condition. It may lead to multiple diagnostic tests and unnecessary aggressive therapies. A recent case report associated aerophagia with a novel concept of abdomi- no-phrenic dyssynergia. Key words: Aerophagia. Abdomino-phrenic dyssynergia. CASE REPORT A 2-year-old child presented to the Emergency Room (ER) due to progressive, abdominal distension that worsened during the night of a one week duration. The patient also presented isolated vomiting, normal stools and irritability in the absence of fever. An abdominal x-ray film identified abundant intra-abdomi- nal air (Fig. 1) with no other abnormal findings. The patient was examined by the Surgery Department and acute abdomen was ruled out. Following a spontaneous clinical improvement, the patient was discharged from hospital. Fifteen days later, the patient returned due to persistent abdominal distension that worsened throughout the day, in association with intermittent vomiting and greenish, foul-smelling stools over the previous ten days. The stool culture was negative and the patient was admitted for assessment. A new radiographic imaging test on admission revealed significant gastric distension. Laboratory tests that includ- ed cell count, liver and kidney function were normal and the anti-transglutaminase antibodies were negative. The child was again assessed by the Surgery Department and gastric volvulus was suspected. A nasogastric tube (NGT) was placed and a liquid diet was maintained. The intesti- nal transit was normal. A transpyloric tube was placed and feeding was started with a basic formula. This was well tol- erated although obvious distension persisted. Accordingly, an open NGT was left in place with intermittent aspiration. However, abdominal distension remained progressive throughout the day. An abdominal computed tomography (CT) scan found no evidence of a malrotation (Fig. 2) but a significant generalized distension from the stomach to the large bowel was identified. A total of 2.5 liters of gas per 24 hours were recovered from the NGT. The patient remained symptomatic and a macronutrient intolerance was excluded. An endoscopic examination found no abnormal changes that could account for the symptoms and clinical presentation. The diet was changed Aerophagia due to abdomino-phrenic dyssynergia in a 2-year-old child Pablo Ercoli 1 , Belinda García 1 , Enrique del Campo 2 and Sergio Pinillos 1 Services of 1 Gastroenterology, Hepatology and Nutrition and 2 Phisiotherapy. Hospital Sant Joan de Déu. Barcelona, Spain Ercoli P, García B, Del Campo E, Pinillos S. Aerophagia due to abdomino-phre- nic dyssynergia in a 2-year-old child. Rev Esp Enferm Dig 2018;110(5):332- 333. DOI: 10.17235/reed.2018.5444/2017 Received: 10/01/2018 · Accepted: 07/02/2018 Correspondence: Pablo Javier Ercoli. Service of Gastroenterology, Hepatology and Nutrition. Hospital Sant Joan de Déu. Pso. Sant Joan de Déu, 2. 08950 Esplugues de Llobregat, Barcelona. Spain. e-mail: pabloercoli@gmail.com Fig. 1. Posteroanterior abdominal x-ray in a standing position. 1130-0108/2018/110/5/332-333 • REVISTA ESPAÑOLA DE ENFERMEDADES DIGESTIVAS © Copyright 2018. SEPD y © ARÁN EDICIONES, S.L. REV ESP ENFERM DIG 2018:110(5):332-333 DOI: 10.17235/reed.2017.5444/2017