Robert R. Schade, MD, FACG1, Iryna S. Hepburn, MD2 1Wellspan Digestive Heallth, Lebanon, PA; 2Wellspan Health, Lebanon, PA
Introduction: We present a case with failure to thrive in which solving one issue- dysphygia and dysgeusia leading to under nutrition unmasked another: small bowel ischemia.
Case Description/Methods: The patient is an 84-year-old male who presented to the office complaining of abdominal pain, weakness, lightheadedness, and inability to tolerate oral feeding, stating he was unable to swallow solids. Referred to the emergency room, he was found to have diverticulitis and mild anemia and was treated as an outpatient. Subsequently, he was seen for 2 weeks later, and he complained of the same failure to thrive and difficulty swallowing. EGD was performed, and no stricture or esophageal inflammation or candidasis was found. A speech pathology evaluation with barium study found no swallowing disorder. Due to his failure to thrive, a PEG tube was placed. He continued to have trouble with oral feedings and had confusion about how to use the PEG tube, taking in very little nutrition by mouth or by tube. Seen in the office later, he mentioned that he had a metallic taste in his mouth, causing his poor appetite, as all food was distasteful. Zinc level was obtained, and he was found to be deficient at 58 mcg/mL (nl >60) . He was started on a zinc supplements, and his appetite and oral intake improved. He started eating more food orally, while continuing PEG feedings. He developed post-prandial abdominal pain and was seen in the hospital. CT angiogram was obtained and found severe superior mesenteric artery stenosis >90% as well as ileus and small bowel wall thickening with intramural pneumatosis. Two days later, a CT scan showed improvement of the ileus, but now gas was seen in the portal venous system. He was referred to a tertiary care center for management of small bowl ischemia. He was treated conservatively with aspirin and Plavix. Months later, he has gained weight and is doing well.
Discussion: This case highlights the importance of a careful history, especially to discern differences in swallowing disorders versus dysgeusia and dysphagia. Once Dysgeusia was corrected, the patient experienced bowl ischemia due to increased oral intake. It also demonstrates how resolving one problem can unmask another, especially in an elderly patient.
Robert Schade indicated no relevant financial relationships.
Iryna Hepburn indicated no relevant financial relationships.
Robert R. Schade, MD, FACG1, Iryna S. Hepburn, MD2. P1997 - Too Much of a Good Thing, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.