University of Puerto Rico School of Medicine San Juan, United States
Juan G. Feliciano-Figueroa, MD, Fernando Bonilla-Valentin, MD, Juan Carlos Santiago-Gonzalez, MD, Vanessa Sepúlveda-Rivera, MD, Pablo Costas-Caseres, MD University of Puerto Rico School of Medicine, San Juan, Puerto Rico
Introduction: Gastroparesis consists of delayed gastric emptying of luminal contents in the absence of mechanical obstruction. This disease has a prevalence of 9 to 13 per 100,000 and the most common causes include surgery involving the vagal trunks, idiopathic, diabetes mellitus (DM), or iatrogenic. Here we present a case of gastroparesis caused by an aortic dissection (AD).
Case Description/Methods: This is a 60-year-old male with a medical history of arterial hypertension, DM type II, and obesity who came to our ER due to a hypertensive emergency with CNS as a target organ. Blood pressure was remarkable for 259/123. The other vital signs were normal. Physical exam was remarkable for altered mental status. Laboratories showed impaired renal function without electrolyte abnormalities. Glycosylated hemoglobin was 6.8%. The patient was admitted to the ICU for IV antihypertensive medication. A regular diet was provided with initial adequate tolerance. Five days later, he developed crushing chest pain that radiated to the back. An AD was suspected and confirmed by imaging studies. Due to the distribution of the AD type B, conservative management was recommended. Two days later, the patient started with nausea and vomits, and developed abdominal distention. Physical examination was remarkable for a distended and tympanic abdomen without peritoneal signs. A CT scan showed a distended stomach full of oral contrast after two hours of ingestion. Initial bowel rest was provided, but patient failed a subsequent oral trial. An upper endoscopy was performed which did not demonstrate signs of gastric outlet obstruction or bowel wall ischemia. Due to the critical state of the patient a nuclear gastric emptying study was not performed. A slow oral trial including a promotility agent with every meal was commenced. After gradual progression of diet, the patient achieved his baseline gastrointestinal tolerance.
Discussion: This vignette illustrates a unique presentation of gastroparesis precipitated by an AD. We understand that this delayed gastric emptying could be multifactorial. Vagal nerve disruption caused by the proximity to the dissected aorta or a transient hypoperfusion state caused by the AD could explain this phenomenon. To our knowledge, there are no cases reporting severe gastroparesis after an AD.
Figure: KUB showing severe distention of Stomach after Aortic Dissection Type B
Disclosures: Juan Feliciano-Figueroa indicated no relevant financial relationships. Fernando Bonilla-Valentin indicated no relevant financial relationships. Juan Carlos Santiago-Gonzalez indicated no relevant financial relationships. Vanessa Sepúlveda-Rivera indicated no relevant financial relationships. Pablo Costas-Caseres indicated no relevant financial relationships.
Juan G. Feliciano-Figueroa, MD, Fernando Bonilla-Valentin, MD, Juan Carlos Santiago-Gonzalez, MD, Vanessa Sepúlveda-Rivera, MD, Pablo Costas-Caseres, MD. P1034 - Aortic Dissection: An Atypical Etiology of Severe Gastroparesis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.