title: Intractable hiccup: an odd complication after laparoscopic fundoplication for gastroesophageal reflux disease.
abstract: Intractable hiccup can be an unbearable circumstance and its treatment is often frustrating. More than 100 causes for hiccup have been described in the literature; the most common cause is gastroesophageal reflux disease (GERD). We report a case of a 31-year-old patient who suffered from intractable hiccup starting 3 weeks after laparoscopic Nissen fundoplication for GERD, a potential surgical complication that has not been described. After frustrating medical treatment, the patient underwent computed tomography and nerve stimulator-guided blockade of vagal and phrenic nerves on each side separately. Hiccup ceased only after blockade of the right phrenic nerve with 4 ml/h l% ropivacaine and relapsed soon after discontinuation. He underwent thoracoscopic right phrenicectomy, which rendered him symptom free for well over 2 months, at the time of this writing.
authors.affiliation: Department of Surgery, University Hospital Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. strate@uke.uni-hamburg.de
authors.forename: T
authors.initials: T
authors.lastname: Strate
authors.forename: T E
authors.initials: TE
authors.lastname: Langwieler
authors.forename: O
authors.initials: O
authors.lastname: Mann
authors.forename: W T
authors.initials: WT
authors.lastname: Knoefel
authors.forename: J R
authors.initials: JR
authors.lastname: Izbicki
mesh_terms: D000328:Adult; D018662:Fundoplication / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000601:surgery*; D006606:Hiccup / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D009407:Nerve Block; D010791:Phrenic Nerve / Q000187:drug effects / Q000601:surgery; D011183:Postoperative Complications / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D014630:Vagus Nerve / Q000187:drug effects