| 제목 |
Esophagostomy, an alternation of PEG or PRG for dysphagia in muscular dystrophy : A case report |
| 소속 |
Eulji University Hospital, Department of Rehabilitation Medicine1 |
| 저자 |
Jin Seok Bae1*, Jong Keun Kim1, Yong Sung Jeong1, Hyo Sik Park1, Jong Youb Lim1, Kang Jae Jung1† |
Introduction
The muscular dystrophy is a group of disease that causes weakness and loss of mass. Progressive mobility impairment and dysphagia may limit the ability of the patient with a myopathy to self-feed. When feeding becomes insufficient to meet the patient’s needs, a discussion should address treatment strategies including the placement of a gastrostomy tube. We report that performed other methods, esophagostomy when we were unable to do gastrostomy.
Case Report
A 40-year-old man known as muscular dystrophy admitted to the Department of Rehabilitation Medicine to perform gastrostomy tube for deteriorated dysphagia. He applied a home ventilator for all day long. The patient could not use a nasogastric tube because he applied a mask. Also, it was difficult to perform endoscopic gastrostomy, so we planned radiologic gastrostomy. He took chest and abdomen radiograph for further evaluation.
Abdomen radiograph showed paralytic ileus. Radiologic gastrostomy or jejunostomy was considered to be high risk because transverse colon was located on the stomach and jejunum. Therefore, there was no space for entering gastrostomy or jejunostomy. By using an orogastric and rectal tube, abdominal decompression was performed. However, paralytic ileus did not improve. Finally, we consult the Department of Radiology to perform fluoroscopy guided esophagostomy. After esophagostomy, there was no complication The patient could get sufficient nutritional support by esophagostomy tube. After 2 weeks, the patient was able to oral feeding.
Conclusion
In severe myopathies, individuals may develop nutritional inadequacy as their disease progress. When feeding becomes insufficient to meet the patient’s needs or the time and effort required for consuming meals negatively impacts the quality of life, a discussion should address treatment strategies. Esophagostomy can be a good treatment option that can be performed in patients who do not undergo percutaneous endoscopic gastrectomy or jejunostomy.
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Figure 1. Simple x-ray showed Esophagostomy tube.
Figure 2. CT showed colonic gas in front of stomach.
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