A Case Report on Gastroparesis Secondary to a Posterior Fossa Tumor.

Abstract

Introduction. Gastroparesis is an uncommon condition with scarce available literature. The presented child had a three-month history of persistent unexplained vomiting and inability to maintain adequate nutrition with severe gastroparesis on gastric emptying study. He was refractory to medical and surgical management. 
 Case Report. A 20-month-old male was brought into the ED and diagnosed with gastroenteritis. Abdominal X-ray was normal, and the vomiting persisted despite antiemetic (ondansetron) administration. He was started on bethanechol for gastroparesis, which was changed to intravenous metoclopramide as he did not tolerate the oral route. His presentation further progressed with intracranial hypertension, hydrocephalus, seizure, and acute respiratory failure necessitating intubation. He was subsequently diagnosed with an atypical teratoid rhabdoid tumor of the cerebellum, for which pediatric neurosurgery performed surgical resection.
 Discussion. The patient was initially diagnosed with post-viral gastroparesis; however, he had shown poor response to medical and surgical therapy and later presented with developmental regression and signs of increased intracranial pressure leading to the diagnosis. In this case, we speculate that the development of gut dysmotility results from disruption of the dorsal motor nucleus of the vagus and autonomic nuclei in the brain stem, which may also have been the reason for medication resistance. 
 Conclusion. Pediatric gastroparesis is largely diagnosed as idiopathic; however, clinicians should be vigilant to look for secondary causes, especially in treatment-resistant cases.