scholarly journals Improvement of Cyclic Vomiting Syndrome with Outpatient Ketamine Infusions

2021 ◽  
pp. 9-16
Author(s):  
Anna Carpenter ◽  
David J. Levinthal ◽  
David G. Binion ◽  
Trent Emerick
Keyword(s):  
Chronic Pain ◽  
Abdominal Pain ◽  
Prophylactic Treatment ◽  
Chronic Abdominal Pain ◽  
Inpatient Admission ◽  
Nausea And Vomiting ◽  
Cyclic Vomiting Syndrome ◽  
Prophylactic Therapy ◽  
History Of ◽  
Cyclic Vomiting

Cyclic vomiting syndrome (CVS) is a disorder characterized by recurrent flares of nausea and vomiting, often with significant abdominal pain, of several days duration. Although traditional prophylactic and abortive treatments for CVS are often successful, a subset of CVS patients with chronic abdominal pain may not respond as well to standard therapies. This report is the first, to our knowledge, to describe the use of outpatient ketamine infusions as therapy for refractory CVS. We describe a 63-year-old woman with history of CVS who presented with abdominal pain and recurrent episodes of nausea and vomiting. She first received ketamine during an inpatient admission for a CVS flare, with the aim of treating the abdominal pain. Given her improvement, she was offered a series of outpatient ketamine infusions, which led to a significant reduction in her symptoms. Thus, ketamine may be useful as both an abortive and prophylactic therapy in CVS. Prior reports have noted the anti-emetic effects of ketamine in the perioperative setting, and there is emerging evidence for the use of ketamine infusions for the treatment of chronic pain. However, this report is the first to describe ketamine as a potential prophylactic treatment for CVS.

A case-report of migraine “sine headache”

Cephalalgia ◽  
2017 ◽  
Vol 38 (3) ◽  
pp. 592-594
Author(s):  
Arens Taga ◽  
Marco Russo ◽  
Antonio Genovese ◽  
Gian Camillo Manzoni ◽  
Paola Torelli
Keyword(s):  
Case Report ◽  
Female Patient ◽  
Migraine Without Aura ◽  
Nausea And Vomiting ◽  
Cyclic Vomiting Syndrome ◽  
Full Spectrum ◽  
Abdominal Migraine ◽  
Associated Symptoms ◽  
History Of ◽  
Cyclic Vomiting

Background and objectives We describe a case of a female patient whose otherwise “typical” migraine attacks turned into episodes with a full spectrum of associated symptoms but without headache. Case report We evaluated a 53-year-old woman with a long history of migraine without aura. In concomitance with premenopausal menstrual dysregulation, she reported episodes of nausea and vomiting, associated with photophobia, phonophobia and osmophobia, but without headache; these episodes were responsive to oral triptans. Alternative diagnoses were excluded through extensive examinations. Discussion To date, no reports have been published in the literature on otherwise typical migraine attacks that are not accompanied by headache, nor did our case seem comparable to cases of abdominal migraine and cyclic vomiting syndrome. Conclusion Pathophysiologically, we hypothesize that functional dysregulation of the hypothalamus-brainstem connectivity may generate migraine attacks with a full spectrum of associated symptoms but without pain.

Associations Between Physical Activity and Chronic Pain Severity in Youth With Chronic Abdominal Pain

2019 ◽  
Vol 35 (7) ◽  
pp. 618-624 ◽  
Author(s):  
Tiffany Kichline ◽  
Christopher C. Cushing ◽  
Adrian Ortega ◽  
Craig Friesen ◽  
Jennifer V. Schurman
Keyword(s):  
Physical Activity ◽  
Chronic Pain ◽  
Abdominal Pain ◽  
Chronic Abdominal Pain ◽  
Pain Severity

Sumatriptan in the Treatment of Cyclic Vomiting

1995 ◽  
Vol 29 (10) ◽  
pp. 997-999 ◽  
Author(s):  
John M Benson ◽  
Sherri L Zorn ◽  
Linda S Book
Keyword(s):  
Abdominal Pain ◽  
Subcutaneous Injection ◽  
Migraine Headache ◽  
Agonist Activity ◽  
Single Subcutaneous Injection ◽  
Serotonin Agonist ◽  
Case Summary ◽  
History Of ◽  
Time Of Admission ◽  
Cyclic Vomiting

Objective: To describe a patient with cyclic vomiting who was treated successfully with sumatriptan, a serotonin, agonist. Case Summary: A patient with a 4-year history of cyclic vomiting was treated for an episode of nausea, vomiting, and abdominal pain. This patient had been hospitalized numerous times for cyclic vomiting over the previous 4 years, each hospitalization lasting from 3 to 11 days. Following a single subcutaneous injection of sumatriptan 6 mg, the patient ceased vomiting and was discharged 40 hours from the time of admission. Discussion: The efficacy of sumatriptan in migraine headache appears to be mediated through its agonist activity at the serotonin1D receptor, resulting in constriction of dural blood vessels. According to published reports, therapeutic attempts at controlling cyclic vomiting often have included antimigraine therapies. Consistent with these reports, sumatriptan also appears effective in the treatment of cyclic vomiting. Conclusions: The pathogenesis of cyclic vomiting appears to share similarities with classic migraine, both of which may respond to sumatriptan therapy according to this report and previous work. Further study of the use of sumatriptan in the treatment of cyclic vomiting appears warranted.

scholarly journals Use of methylene blue in the prevention of recurrent intra-abdominal postoperative adhesions

2017 ◽  
Vol 46 (1) ◽  
pp. 504-510 ◽  
Author(s):  
Octavian C. Neagoe ◽  
Mihaela Ionica ◽  
Octavian Mazilu
Keyword(s):  
Methylene Blue ◽  
Abdominal Pain ◽  
Abdominal Surgery ◽  
Beneficial Effect ◽  
Adhesion Formation ◽  
Chronic Abdominal Pain ◽  
Postoperative Adhesions ◽  
Similar Time ◽  
History Of

Objective To evaluate the efficacy of methylene blue in preventing recurrent symptomatic postoperative adhesions. Methods Patients with a history of >2 surgeries for intra-abdominal adhesion-related complications were selected for this study. Adhesiolysis surgery was subsequently performed using administration of 1% methylene blue. The follow-up period was 28.5 ± 11.1 months. Results Data were available from 20 patients (seven men and 13 women) whose mean ± SD age was 51.2 ± 11.4 years. Adhesions took longer to become symptomatic after the first abdominal surgery when the initial pathology was malignant compared with benign. However, the recurrence of adhesions after a previous adhesiolysis surgery had a similar time onset regardless of the initial disease. Following adhesiolysis surgery with methylene blue, the majority of patients did not present with symptoms associated with adhesion complications (i.e., chronic abdominal pain, bowel obstruction) for the length of the follow-up period. Conclusions The use of methylene blue during adhesiolysis surgery appears to reduce the recurrence of adhesion-related symptoms, suggesting a beneficial effect in the prevention of adhesion formation.

scholarly journals Migrated Tubal Ligation (Filshie) Clip as an Uncommon Cause of Chronic Abdominal Pain

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Sahil Sharma ◽  
Radek Martyniak ◽  
Vladislav Khokhotva
Keyword(s):  
Abdominal Pain ◽  
Fertility Control ◽  
Left Lobe ◽  
Tubal Ligation ◽  
Chronic Abdominal Pain ◽  
Pathology Report ◽  
Patient Reported ◽  
Surgical History ◽  
History Of ◽  
Gastrohepatic Omentum

Tubal ligation (TL) is an effective and common method of fertility control. In the year 2009, over 24,000 were performed in Canada alone. Migration of Filshie clips used during TL is estimated to occur in 25% of all patients; 0.1-0.6% of these patients subsequently experience symptoms or extrusion of the clip from anatomical sites such as the anus, vagina, urethra, or abdominal wall. Migrated clips may present as chronic groin sinus, perianal sepsis, or chronic abdominal pain. These symptoms can occur as early as 6 weeks or as late as 21 years after application. We present the case of a 49-year-old female with a 3.5-year history of intermittent dull nonradiating left upper quadrant (LUQ) pain lasting on average 2-3 days. There were no other associated symptoms, and the longest pain-free period was 4 days. Her past medical history includes COPD, GERD, IBS, and depression. Current medications are only remarkable for Symbicort. Pertinent past surgical history includes laparoscopic tubal ligation with Filshie clips in 1999, followed by a vaginal hysterectomy in 2013. Migrated tubal ligation clip was noted on an abdominal X-ray. The patient was then referred for surgical management. Subsequent CT scan confirmed a solitary clip present adjacent to the left lobe of the liver. No other abnormalities were reported. Patient underwent laparoscopy for removal of the clip, which was identified to be underneath the left lobe of the liver embedded in the gastrohepatic omentum. Please see the video link provided. Postoperative pathology report confirmed the presence of a Filshie clip. Patient reported complete resolution of her LUQ pain at a 5-week and 3.5-month follow-up. This case shows that although symptomatic clip migration is a rare phenomenon, it should be given special consideration in women with unexplained chronic abdominal pain and a history of TL. Additionally, removal of clip can provide resolution of symptoms.

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