Intermittent bursts of abdominal wall jerky movements: belly
The present case has been reported in BMJ.

A 47-year-old 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, these movements 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.

Learning points
• Belly dancer's syndrome is a form of diaphragmatic myoclonic jerks (or flutter) which can result in chest and/or abdominal pain and dyspnoea. Therefore, an alternative diagnosis usually comes to mind.

• Clinically, frequent, intermittent and often rhythmic involuntary undulations of the abdomen are observed.

• Diaphragmatic fluoroscopy and electromyography are the key diagnostic tools. In spite of the long list of pathologically defined causes behind this syndrome, several cases are idiopathic and some are psychogenic.

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