Palpable abdominal mass of pediatric origin

Specialty: Pediatrics.

• Childhood abdominal tumor
• palpable mass in the abdomen of children

Why it occurs

• Severe fecal impaction or fecal impaction (most common benign medical cause in all pediatric ages)
• Congenital hydronephrosis or polycystic kidney (mass of renal origin, more common in neonates and small infants)
• Neuroblastoma (most common extracranial solid tumor in infants, derived from the neural crest cells of the adrenal gland or sympathetic chain)
• Wilms tumor or nephroblastoma (most common malignant kidney tumor in childhood, typically diagnosed between 2 and 5 years of age)
• Intestinal intussusception (elastic mass in the shape of a "sausage", of acute onset, associated with severe cramping abdominal pain)
• Chole duct cyst or massive splenomegaly (secondary to hematological or portal pathology)

Initial workup

Abdominal ultrasound with color Doppler (initial, rapid, non-invasive and highly sensitive first-line test to define whether the mass is cystic, solid, free or dependent on a specific organ). Computed Tomography (CT) or Magnetic Resonance (MRI) of the abdomen and pelvis with contrast (studies of choice for staging, vascular relationships and local infiltration of tumor masses). Determination of catecholamines in 24-hour urine or in an isolated sample: vanilmandelic acid (VMA) and homovanillic acid (AHV) when neuroblastoma is suspected. Complete general analysis: complete blood count (ruling out anemia or thrombocytopenia), renal profile (urea, creatinine), liver profile, lactate dehydrogenase (LDH, nonspecific tumor marker) and systematic urine examination.

Standard management

• The treatment of pediatric neoplastic masses is strictly oncological — neoadjuvant chemotherapy, surgical resection and/or radiotherapy according to international cooperative protocols). In case of benign fecal mass (fecaloma): Polyethylene glycol 3350 with electrolytes (disimpaction dose of 1.5 g/kg/day orally for 3 to 6 days
• Support analgesic treatment with Paracetamol (15 mg/kg/dose) or Ibuprofen (10 mg/kg/dose) if mild non-surgical pain is associated.