Hipo persistente: una rara complicación de una inyección epidural transforaminal de corticoides / Persistent hiccup: a rare complication of a transforaminal epidural corticoid injection / Soluços persistentes: uma complicação rara da injeção peridural transforaminal de corticosteroide

Se describe el caso de un paciente que instaló un hipo persistente luego de recibir una inyección epidural transforaminal lumbar de corticoides. Se destaca que es una complicación raramente reportada y por ende poco conocida por quienes practican intervencionismo en dolor. Se discuten los posibles mecanismos por los que puede presentarse, se reseña la evolución observada, y se describe el tratamiento instituido. Se señala el impacto que el hipo puede tener sobre la calidad de vida.

The case of a patient who installed a persistent hiccup after receiving a lumbar transforaminal epidural injection of corticosteroids is described. It is highlighted that it is a rarely reported complication and little known by those who practice interventional pain medicine. Possible mechanisms by which it may occur are discussed, the evolution observed and the treatment instituted are reviewed. The impact that hiccups can have on quality of life is pointed out.

Descrevemos o caso de um paciente que desenvolveu soluços persistentes após receber uma injeção peridural transforaminal lombar de corticosteróides. Ressalta-se que é uma complicação pouco relatada e, portanto, pouco conhecida por quem pratica o intervencionismo na dor. Discutem-se os possíveis mecanismos pelos quais pode ocorrer, revisa-se a evolução observada e descreve-se o tratamento instituído. O impacto que os soluços podem ter na qualidade de vida é apontado.

Hipo Persistente como forma de presentación de la enfermedad por reflujo gastroesofágico / Persistent hiccup as a presentation form of the disease for gastro-esophageal reflux

El hipo persistente (singultus) es aquel que se presenta en forma de un ataque prolongado o ataques recurrentes durante un tiempo determinado, generalmente más de 48 horas, suele resolverse sin tratamiento farmacológico, pero puede ser necesario administrarlo y plantear su estudio etiológico. Esta entidad infrecuente se presenta en un hombre de 63 años, con historia de singultus desde hace tres años, que aparece fundamentalmente posterior a la ingestión de alimentos y persiste durante varios minutos u horas, todos los días. Las causas del singultus pueden ser gastrointestinales (reflujo gastroesofágico, hernia del hiato, esofagitis, úlcera gástrica, pancreatitis, carcinoma esofágico, masas hepáticas, ascitis, cirugía abdominal), neurológicas, vasculares, torácicas, metabólicas, tóxicas, fármacos y otras. Se le realiza interrogatorio y examen físico minucioso, electrocardiograma, rayos X de tórax y abdomen, analítica sanguínea, ultrasonido abdominal, Endoscopia superior, tomografía de tórax y abdomen, además de Manometría esofágica y la prueba terapéutica con omeprazol, diagnosticándose una enfermedad de reflujo gastroesofágico. Se pone tratamiento basado en medidas populares, y medicamentos del síntoma fundamental con cloropromacina (tabletas de 25mg): 1 tableta cada 8 horas, obteniendo mejoría ostensible del mismo, hasta el momento en que se diagnóstica la causa etiológica, donde se pone tratamiento específico de la enfermedad de reflujo gastroesofágico con omeprazol (20mg): 1 Cápsula cada 12 horas y domperidona, obteniendo la desaparición del síntoma que causó la consulta inicial del paciente.

The persistent hiccup (singultus) is the one that shows up as a prolonged attack or recurrent attacks during a determinant period of time, generally, more than 48 hours. It uses to resolve without a pharmacological treatment, but it could be necessary a treatment and posing its etiological study. This infrequent entity is presented in a man, aged 63 years, with a history for three years, appearing mainly after the food intake and persisting for several minutes or hours, every day. The singultus’s causes may be gastrointestinal (gastro-esophageal reflux, hiatal hernia, esophagitis, gastric ulcer, pancreatitis, esophageal carcinoma, hepatica masses, ascites, abdominal surgery), neurological, vascular, thoracic, metabolic, toxic, medicine, and others. We performed a questioning and a meticulous physical examination, an electrocardiogram, thorax and abdominal X-rays, blood analyses, abdominal ultrasound, superior endoscopy, thoracic and abdominal tomography, in addition to esophageal manometry and the therapeutic test with Omeprazol, diagnosing a gastro-esophageal reflux disease. We prescribed a treatment based on popular measures, and medication for the main symptom with chlorpromazine (25 mg tablets): 1 tablet each 8 hours, achieving a clear improvement of the symptom until the moment when the etiological cause was diagnosed and a specific treatment for the gastro-esophageal reflux disease was ordered with omeprazole (20 mg): 1 capsule each 12 hours and domperidona, reaching the disappearance of the symptom that caused the patient´s initial consultation.

Hipo (singultus): revisión de 24 casos / Hiccup: Review of 24 cases

Background: Although common and usually benign, hiccups can be an extremely uncomfortable disease. There is not much information about persistent and refractory hiccups. Aim: To report clinical features of patients admitted in a hospital due to hiccup. Patients and Methods: A retrospective study and prospective follow up of patients admitted for hiccup in Hospital Cl¡nico de Santiago de Compostela between January 1998 and May 2005. Results: Twenty four patients (age 47 to 91 years, 23 males) were studied. Nineteen (79 percent) were admitted because of persistent hiccups. In twenty one patients, at ¡east one organic etiology was identified, and thirteen patients presented two or more possible associated conditions. The most common possible causes were digestive tract disorders, followed by central nervous system diseases. Twelve patients had a history of exposure to drugs that potentially could cause hiccups, mainly corticosteroids and benzodiazepines. Chlorpromazine was the first choice treatment in 23 patients, but seven required a second line drug. Average hospital stay was 13 days (range 3-90 days). Twelve patients died during follow up. Death occurred during the first three months of follow up in 61 percent. Conclusions: Persistent hiccup is often associated with organic conditions, specially advanced tumors of the digestive tract. It is usually associated with a bad prognosis.