Postviral gastroparesis in an infant with late Bochdalek diaphragmatic hernia

Abstract

Gastroparesis is a delay in gastric emptying, without a mechanical cause, in childhood, usually idiopathic. It can also arise iatrogenicly or after infection. It presents with vomiting, early satiety, and abdominal pain.1,2,3 This case involves a previously healthy 7-month-old infant who presented to the emergency room with a respiratory infection and intractable vomiting, with sustained bowel movements. Upon admission, he underwent a positive viral panel for SARS-CoV-2 and a chest X-ray. This image was suggestive of Bochdalek congenital diaphragmatic hernia (CDH), as well as frank gastric distension (from the thorax to the hypogastrium) with contents. Ultrasound did not identify gastric movements. Due to suspicion of post-viral gastroparesis, he was hospitalized for symptomatic treatment. After one month of hospitalization, the child was still dependent on parenteral nutrition (PN), but nutritionally stable. The patient underwent laparotomy for correction of CDH (herniated stomach and spleen) and placement of a nasojejunal tube. The postoperative period was favorable. It was possible to wean the patient off parenteral nutrition with continuous enteral feeding, then bolus feeding, and after 20 days, oral feeding. The patient was discharged on postoperative day 22. Eight months post-surgery, the patient has adequate development without complications. The importance of a multidisciplinary team in managing a patient with distinct pathologies, both impacting the resolution of food intolerance, is highlighted. This also reinforces the findings in the literature regarding the uncertain duration of resolution of gastroparesis, in the therapeutic challenge of treating this condition.