Intractable hiccup: an odd complication after laparoscopic fundoplication for gastroesophageal reflux disease.
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.
Strate
T
T
Department of Surgery, University Hospital Eppendorf, Martinistrasse 52, D-20246 Hamburg, Germany. strate@uke.uni-hamburg.de
Langwieler
T E
TE
Mann
O
O
Knoefel
W T
WT
Izbicki
J R
JR
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