Gastrostomy for gaseous decompression in quadriplegic man: case report
1991
Summary A case of percutaneous endoscopic gastrostomy in a quadriplegic patient with aerophagia and symptomatic chronic gastric distention is presented. Gastrostomy is an accepted proce dure for acute and chronic gastric distention in veterinary medicine. In the aerophagic quadriplegic population, this is a viable therapeutic option after failure of medical therapy. Aerophagia in the adult quadriplegic is a significant clinical problem for which no defmite treatment exists. Gastrostomy for feeding and decompression is an estab lished surgical procedure for various indications, and veterinary surgeons employ it to relieve acute and chronic gaseous distention in cattle and dogs. We present a case in which percutaneous endoscopic gastrostomy (PEG) was performed for relief of symptomatic gastric distention in a high-risk quadriplegic patient whose abdomi nal pain and bloating due to aerophagia were refractory to medical management. In our experience in a Department of Veterans Affairs Spinal Cord Injury Cen ter, we have noted chronic gastric dilatation in many quadriplegic patients, appar ently due to aerophagia, and we have treated several patients medically for upper abdominal pain and bloating. It is interesting to speculate whether this condition is caused by a gastro-pyloric dyssynergia analogous to the bladder and anorectal dys synergias found in spinal cord injury patients, and whether inability to belch through unchecked diaphragmatic pressure on the oesophagus is a contributing factor. The preponderance of older individuals with this condition may point to an aetiologic role for chronic anticholinergic administration in gastric hypotony and hypomotility.
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