Gastrostomy for gaseous decompression in quadriplegic man: case report

Abstract

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.