Description

A 47-year-old Iraqi Kurdish woman presented with a 1-day history of sudden onset of frequent, intermittent and painful abdominal wall jerky movements, 6 days after undergoing haemorrhoidectmy. During sleep, these movements were absent. The postoperative period was uneventful and the patient was discharged home on day 2 with oral clindamycine and metronidazole. The appearance of these movements prompted the A&E interns to think about intestinal obstruction and accordingly they consulted the general surgical department; the surgeon suggested symptomatic treatment with watchful waiting and nothing by mouth. However, on day 3, we were asked to examine the patient; these movements (video 1) represented belly dancer's syndrome. Brain and spinal MRI were unremarkable, as were her blood tests, chest CT scan and transthoracic echocardiography; diaphragmatic fluoroscopy and abdominal wall/diaphragmatic electromyography were not done. She was prescribed intravenous diphenhydramine and oral diazepam; her complaints disappeared completely 3 days later and have never recurred.

Belly dancer's syndrome (or diaphragmatic flutter) refers to myoclonic jerks involving one or both hemidiaphragms, which are involuntary, repetitive, usually painful and often rhythmic, and result in visible undulating movements of the abdomen (and sometimes the trunk), an appearance which resembles belly dance. The condition is rare and has a long list of causes. The core feature is a rapid myoclonic contraction and release of the diaphragm, which, in most cases, involves both inspiration and expiration. The majority is bilateral, but unilateral cases usually target the left side. The abdomen is usually painful and the dyspnoea is frequently a prominent complaint.1–3