Innovative Management of Aerophagia-Induced Intestinal Pseudo-Obstruction in an Adult With Severe Intellectual Disability: A Case Report

Intestinal pseudo-obstruction caused by aerophagia is predominantly observed in children with developmental delays, and adult cases are rare. Cases are typically managed symptomatically because there are no known effective treatments. We report here a successful response to intestinal pseudo-obstruction in an adult patient presenting with chronic abdominal distention. A 67-year-old woman with severe intellectual disability was admitted to our hospital with vomiting, fever, and dyspnea. Imaging revealed aspiration pneumonia and significant gas accumulation in the stomach and intestines. During hospitalization, the cause of the intestinal pseudo-obstruction was identified as aerophagia due to frequent and involuntary swallowing of saliva. Clonazepam and antiparkinsonian drugs were administered to reduce the severity of the salivation, and abdominal massage and intestinal prokinetic agents were used to promote the expulsion of colonic gas. Although these techniques provided symptomatic relief, the underlying aerophagia remained unresolved, and the gastric and intestinal air volume did not improve. After several days of central venous nutrition, the patient was switched to enteral nutrition. We aimed to minimize the passage of air from the stomach into the intestines through a variety of methods, including (1) the use of enteral nutrition that immediately solidified in the stomach, (2) decreased meal frequency to twice daily, (3) placement of a 16 Fr nasogastric tube that was kept open at all times except when enteral nutrition was administered, and (4) positioning of a gastric tube at a depth of 5-10 cm from the gastric cardia so that air stored in the gastric fundus could be easily drained through the nasogastric tube. These procedures dramatically reduced the gastric and intestinal gas volume, and the abdominal distention resolved. The aspiration pneumonia was successfully treated, and 10 days after the above procedures were implemented, there was no recurrence of gastric and intestinal gas retention, and the patient was discharged for home care. It is not clear whether the procedures utilized in our case would be effective in pediatric patients. However, the approach may be useful for patients with chronic abdominal distension due to aerophagia, especially in home care settings.