St. Louis University Hospital St. Louis, MO, United States
Victoria Costello, MD1, Jill Elwing, MD2, Gregory Sayuk, MD2, Michael Presti, MD2 1St. Louis University Hospital, St. Louis, MO; 2John Cochran VA Medical Center, St. Louis, MO
Hiccups (singultus) are spontaneous contractions of the diaphragm. While they often are a short-lived nuisance, significant distress can result from prolonged cases. We present a case of intractable hiccups unresponsive to numerous medical interventions, which resolved for 24 hours following phrenic nerve block.
Case Description/Methods: Case Report:
A 56-year-old male with a history of a gunshot wound to his head and possible cerebrovascular accident 30 years ago presented to gastroenterology clinic for intractable hiccups. The onset of his symptoms was shortly after his head injury, and thereafter his longest symptom-free period was one year. Hiccups initially occurred every several days, but became a daily occurrence 5 years prior to presentation. Prior workup included neurology referral and trials of numerous medications without benefit. He had multiple esophagogastroduodenoscopy (EGD) evaluations. These initially showed mild esophagitis which resolved on more recent EGDs, and his reflux symptoms were controlled. An endoluminal functional lumen imaging probe (EndoFLIP) ruled out any major motility disorder. Given his intractable hiccups, unresponsive to conservative therapy, image guided phrenic nerve block was pursued. His hiccups resolved for 24 hours following the procedure. However, he suffered transient paralysis of the left hemidiaphragm with mild shortness of breath.
Hiccups can be classified based on their duration as acute (< 2 days), persistent (2 days to 1 month), or intractable ( > 1 month). Numerous medication options have been described for hiccup cessation or lifestyle improvement. Unfortunately, these medications all are modest in their efficacy, as was the case with this patient. Given the chronic and disabling nature of this patient’s symptoms, a more invasive intervention was pursued. Phrenic nerve block has been described as potentially useful in prevention of the involuntary phrenic reflex arc from causing diaphragm contracture, resulting in hiccups. Hemidiaphragm paralysis, as was experienced in this case, is a potential complication, and precludes additional treatments, though our patient did have temporary response following the procedure. Therefore, phrenic nerve block can be considered as a salvage approach to hiccup management in patients with intractable symptoms who have failed conservative therapy.
Victoria Costello indicated no relevant financial relationships.
Jill Elwing indicated no relevant financial relationships.
Gregory Sayuk indicated no relevant financial relationships.
Michael Presti indicated no relevant financial relationships.
Victoria Costello, MD1, Jill Elwing, MD2, Gregory Sayuk, MD2, Michael Presti, MD2. P1451 - Intractable Hiccups Treated With Phrenic Nerve Block, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.