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ABSTRACT
We present an unusual case of a 44-year-old male who developed violent hiccups soon after a ureteroscopy for nephrolithiasis; later, the forceful hiccups were followed by hematemesis. Upper esophagogastroduodenoscopy revealed Mallory-Weiss tears and esophageal erosions in the lower esophagus. Esophageal biopsy was unremarkable. The patient did not have a prior history of the gastrointestinal disorder. Although extracorporeal shock wave lithotripsy has on rare occasion been implicated in the development of gastrointestinal erosions, no such correlation exists for ureteroscopy and upper gastrointestinal bleeding in the management of nephrolithiasis. It was the development of violent hiccups for several hours before the onset of hematemesis that likely led to the upper gastrointestinal bleed.
ARTICLE HISTORY
Received 9 September 2016
Accepted 12 December 2016
KEYWORDS
Hiccups; esophageal laceration; hematemesis; Mallory-Weiss
1. Introduction
Hiccups are mostly considered to be benign and selflimited. They are triggered by the activation of the hiccup-reflex-pathway leading to the irritation of the diaphragm. Hiccups, although distressing, have rarely been attributed to gastrointestinal bleeding. This case report documents a yet another rare association between hiccups and upper gastrointestinal bleed due to hiccup-induced Mallory-Weiss tears. Typically, Mallory-Weiss tears are preceded by vomiting and retching. This case highlights that Mallory-Weiss tears could also be triggered by hiccups by causing forceful movements to the diaphragm, and the classical prodromal phase of vomiting and retching may not be necessarily present. It also emphasizes the need for the early institution of therapy in cases of strenuous hiccups, as in rare instances, it may lead to esophageal tears. Recommendations for clinical practice and subsequent practice are discussed.
2. Case report
The patient was a 44-year-old male with past medical history of nephrolithiasis presenting with the chief complaint of hematemesis and epigastric pain. The patient reported that due to his recurrent kidney stones he underwent ureteroscopic procedure four days before presentation. Soon after the ureteroscopic procedure, the patient developed violent hiccups that worsened over the course of time. His severe forceful hiccups were followed by hematemesis which prompted him to visit the emergency department. The patient denied ingestion of alcohol or non-steroidal anti-inflammatory drugs. His vitals were reported to be stable. His labs revealed elevated white cell...