[Enteroparesis caused by progressive fibrosis of the muscularis propria].
We would like to present the case of a 54-year-old patient who was admitted to the hospital with complaints of recurrent vomitus after food intake and associated weight loss. Endoscopy. barium X-ray of the small bowel and scintigraphy showed enteroparesis. Full-thickness biopsies achieved by explorative laparotomy revealed the pathological changes. The inner circular muscular layer was atrophic and replaced by fibrosis. The pathological findings were consistened with either visceral myopathy or isolated intestinal progressive systemic sclerosis. A sporadic nonfamilial type of visceral myopathy seems to be the most likely diagnosis in this case. Progressive systemic sclerosis seems to be unlikely as the patient presented with isolated gastrointestinal involvement and lack of appropriate autoantibodies. The diseases progression made an enteral supplementation impossible. Therefore a parenteral nutrition was started, which was characterized by a complicated clinical course. Persisting gastrointestinal complaints, recurrent port infections and lack of perspectives led to patient's diminished motivation for adequate sterile use of the port-system. This case report shows that besides the use of modern port-systems and antibiotics the psychological situation of patients treated with total parenteral nutrition is of great interest for optimal patient care.
Wedemeyer
J
J
Abteilung für Gastroenterologie und Hepatologie, Medizinische Hochschule Hannover.
Bischoff
S C
SC
Schirmacher
P
P
Walter
G F
GF
Wagner
S
S
Gebel
M
M
Manns
M P
MP
D003937:Diagnosis, Differential; D005355:Fibrosis; D006801:Humans; D007418:Intestinal Pseudo-Obstruction / Q000175:diagnosis* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000473:pathology; D012595:Scleroderma, Systemic / Q000175:diagnosis / Q000473:pathology