Intractable hiccups are a rare yet debilitating pathology with a broad differential and often indicate a more serious underlying pathology, which can range from neoplasms to structural abnormalities. In this case report, we present a 64-year-old male with seven months of intractable hiccups determined to be caused by eventration of the right hemidiaphragm. The patient was treated with baclofen to treat the hiccups pharmacologically. He was also prescribed voice therapy to establish rescue breathing techniques and reduce laryngospasm. Finally, he was referred to thoracic surgery for further evaluation and potential surgical intervention should his diaphragmatic eventration worsen or cause hypoxemia. To our knowledge, this is the first reported case of an association between diaphragmatic eventration and intractable hiccups. It is important to highlight this addition to the broad differential of intractable hiccups and to emphasize an interdisciplinary approach to workup and treatment of intractable hiccups.
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http://dx.doi.org/10.7759/cureus.24430 | DOI Listing |
Heliyon
January 2025
Centro de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia.
Introduction: The area postrema, located on the floor of the fourth ventricle, regulates vomiting, fluid balance, osmoregulation, and immunomodulation. First documented in 1896, it has been a subject of scientific interest ever since. Area postrema syndrome (APS) is characterised by intractable nausea, vomiting, or hiccups, typically associated with neuromyelitis optica spectrum disorder (NMOSD).
View Article and Find Full Text PDFAANA J
October 2024
Chief CRNA at HCA Houston Healthcare Northwest, Houston, Texas. Email:
A 65-year-old male patient presenting with idiopathic, intractable hiccups was to undergo bilateral thoracotomies for phrenic nerve stimulator placement but initially underwent a treatment utilizing the administration of prescriptive positive pressure ventilation as a less invasive treatment option and had successful resolution of hiccups. The patient's hiccups began after a prior hiatal hernia repair and was refractory to pharmacologic treatment and phrenic nerve blocks. Utilizing neuromuscular blockade for diaphragm paralysis and administering three vital capacity breaths to peak inspiratory pressures of 25 cm H2O via endotracheal tube, the patient had successful resolution of symptoms and further surgical intervention was not warranted.
View Article and Find Full Text PDFCureus
August 2024
Internal Medicine, University of Maryland Midtown Campus, Baltimore, USA.
Cureus
July 2024
Family Medicine, LSUHS (Louisiana State University Health Sciences) Shreveport/Rapides Regional, Alexandria, USA.
Neuromyelitis optica (NMO), also known as Devic syndrome, is an autoimmune inflammatory and demyelinating disorder that affects the optic nerves and spinal cord. It is believed to be attributed to aquaporin-4 antibodies, a water channel expressed on astrocytes. It commonly presents with isolated or recurrent attacks of myelitis and optic neuritis.
View Article and Find Full Text PDFReg Anesth Pain Med
August 2024
Vanderbilt University Medical Center, Nashville, Tennessee, USA
Background: Intractable hiccups, defined as those persisting for over 1 month, represent a rare but significant clinical challenge often associated with substantial morbidity and refractory to standard treatments.
Case Presentation: This case report describes the innovative use of phrenic nerve peripheral neuromodulation for managing chronic intractable hiccups in a 73-year-old male patient with a 6-year history of daily hiccups. Conventional treatments and interventional procedures had failed to provide lasting relief.
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