A case report recently published in Cureus describes a teenage patient with Duchenne muscular dystrophy (DMD) who experienced acute gastric dilation, the sudden, abnormal swelling of the stomach.
This case study is significant in that it details a rare but life-threatening complication of DMD. Studies indicate that gastrointestinal dysfunction in DMD is underrecognized, despite being a clinically significant manifestation of the disease.
“[Gastrointestinal] manifestations in DMD are common but often underdiagnosed,” the authors of the report wrote. “Acute gastric dilatation, although rare, represents a potentially life-threatening complication that requires prompt recognition and treatment.”
The 16-year-old patient presented to the emergency department with abdominal pain and hypersecretion in his airways. He had severe scoliosis as well as notable contractures across all four of his limbs, and was nonambulatory.
An examination found that the upper half of his abdomen was distended. He was also classified as having chronic moderate malnutrition according to guidelines issued by the World Health Organization.
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An abdominal X-ray showed that the patient had significant gastric distention; his doctors deemed that this was likely the cause of his abdominal pain. The patient required a nasogastric decompression tube (for the distention). He also received paracetamol.
Laboratory investigations showed that the patient had leukocytosis (i.e., too many white blood cells) and neutrophilia (i.e., too many neutrophils). In addition, he had mildly raised liver and pancreatic enzymes.
The patient was admitted to the hospital so that he could be managed with painkillers, proton pump inhibitors to protect his stomach and receive intravenous fluids.
After 24 hours, his liver and pancreatic enzymes improved. He had his nasogastric tube removed. Nevertheless, he began to complain of abdominal pain that did not respond to painkillers.
An abdominal ultrasound showed large quantities of fluid obstructing the adequate visualization of the pancreas. A computed tomography (CT) scan showed organoaxial gastric volvulus, a condition in which the stomach twists and creates a dangerous and painful close-looped obstruction.
Doctors reinserted the nasogastric decompression tube to drain 2,500 mL of air and fluid; this decompression improved his abdominal pain. The patient was started on prokinetic therapy to help his gastrointestinal system move. A transpyloric tube was inserted due to suspicions of gastroparesis/delayed gastric emptying.
Finally, following pyridostigmine therapy, the patient experienced marked clinical improvement. As the use of the transpyloric tube was likely prolonged, the patient’s doctors added a gastrojejunostomy tube, both for feeding purposes and decompression. Fifteen months later, gastrojejunostomy was switched to a gastronomy tube. Eventually he was able to eat pureed foods with good tolerance.
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