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Intractable hiccups (singultus) are continuous involuntary spasmodic contraction of diaphragm resulting in inspiration followed by closure of glottis. However, it is naturally occurring common phenomenon but intractable hiccups are a continuous form of hiccups which persist for more than 2 months. This can be tough task for physician to found out the organic cause of hiccups. We report a case of 40-year-old female who had hiccups since more than 2 months and she is known case of anxiety neurosis, for which ongoing treatment with anti-depressants and anti-anxiety is going on. Evaluating a psychogenic origin hiccup is the main consequence here.

Melioidosis is an endemic bacterial infection caused by soil saprophyte, Burkholderia pseudomallei. It infects adults with risk factors or immunosuppressed and exposed to moist soil. Its significance lies in its varied clinical presentation and high mortality (40%). We present two cases of abdominal melioidosis with unusual clinical presentations. The first case presented with intractable hiccups and had isolated splenic melioidosis with contained rupture. The second case presented with fever and acute abdominal pain found to have pancreatic melioidosis and splenic vein thrombosis. Both the patients were treated with IV antibiotics and subsequently discharged after improvement in symptoms. The imaging findings of isolated type of melioidosis can mimic various other infections and granulomatous disease. Hence high index of clinical suspicion for patients presenting from endemic areas will narrow down the differential diagnosis.

Persistent and intractable hiccups have a major impact on quality of life and can be a barrier to stroke rehabilitation. The first-line treatment for intractable hiccups, chlorpromazine, can have sedating effects, which may negatively affect rehabilitation participation. Gabapentin has been reported in several cases to be effective in hiccup treatment in both the general and post-stroke populations.To describe the use of gabapentin for treatment of persistent or intractable hiccups in post-stroke patients.Four cases were identified by clinicians for a retrospective review. A literature review was concurrently conducted.This case series presents four patients with improvement or resolution of intractable hiccups on gabapentin in a stroke rehabilitation setting. Therapeutic dose ranged from 100 mg TID to 400 mg BID. Treatment duration ranged from 2 days to 5.5 weeks. Adjuncts were used in three of the cases. A potential side effect was worsened confusion in one case.Evidence on the use of gabapentin for persistent or intractable hiccups is limited. This case series expands on the current literature by examining and comparing the current literature to our cases and exploring issues related to dosing, titration, side effects, and adjuncts to gabapentin.

Highlights • A rare disease was reported in our case: giant hydronephrosis in adult patients. • we reported for the first time that intractable hiccups due to hydronephrosis. • Intractable Hiccup of the patient disappeared after nephrectomy., Introduction Giant hydronephrosis (GH) is a rare disease that is found in adult patients. Although there are some common symptoms associated with hydronephrosis, such as surrounding organ compressed, its rarer symptoms can render diagnosis very difficult, and treatment should also vary according to the cause. Presentation of case We here report an 82-year-old man who was admitted to the hospital for repeated intractable hiccups. After B-ultrasound and CT examination, the patient underwent laparoscopy surgery, which was converted to open nephrectomy, and the patient’s intractable hiccup symptoms disappeared. Discussion GH is a rare disease, and its symptoms are diverse. The more unusual symptoms of cystic hypertonic compression of surrounding organs, such as intractable hiccups, should be taken into account. GH is mainly diagnosed via ultrasound examination and CT scan. The choice of treatment for GH needs to be based on the etiology and renal function of hydronephrosis, and consider malignant lesions. Conclusion Giant hydronephrosis can present rare symptoms as “intractable hiccups”. The selection of treatment should be made depending on the cause.

Thyrotoxicosis manifests when excess levels of thyroid hormone act on different tissues throughout the body. Excess hormone levels can be related to endogenous production or exogenous ingestion and can present differently in patients. It has been theorized that high levels of thyroxine can irritate the neuroanatomical hiccup center leading to persistent hiccups. Although extremely rare, physicians should be aware of this entity to allow for proper diagnosis and management. Here, we discuss a rare case of thyrotoxicosis after an epidural steroid injection presenting with intractable hiccups.

We described an elderly man with neuromyelitis optica spectrum disorder (NMOSD) causing sick sinus syndrome (SSS) following intractable hiccups caused by area postrema syndrome (APS). He had multiple cardiovascular risk factors including coronary angina, diabetes mellitus, hyperlipidemia, and smoking history. His SSS resolved following the disappearance of the hiccups. Clinicians should be aware that severe bradyarrhythmia could be associated with APS, especially in NMOSD patients.

Demyelinating disorders of the central nervous system are diseases that affect the optic nerves, brain, and spinal cord, leading to visual loss, brainstem dysfunction, and locomotor dysfunction. Intractable vomiting is a rare phenomenon seen due to the involvement of the medulla oblongata in neuromyelitis optica, a rare autoimmune demyelinating disorder. We present our experience with a 33-year-old male who presented to our facility with complaints of intractable hiccups. After extensive evaluation, he was found to have parainfectious myelitis. His symptoms completely resolved following institution of appropriate therapy. Through this report, we hope to bring attention to an unusual cause of intractable hiccups that may often go undiagnosed in general practice.

Hiccup is a common phenomenon experienced by almost everyone in life. Although the exact physiology of this phenomenon remains unknown, it is associated with multiple central and peripheral etiologic causes. Vocal fold granulomas are benign laryngeal lesions typically caused by iatrogenic trauma, voice misuse, or chronic irritation. We present, for the first time, an association between intractable hiccups and vocal fold granulomas with good response to acupuncture and voice therapy in a 62-year-old male patient. This is an important contribution to the literature as the first report describing the co-occurrence of these pathologies in the context of a patient with several treatment failures, including vagal nerve stimulator.

Diabetic ketoacidosis (DKA) and thyroid storm (TS) are severe metabolic and endocrine disorders. Both usually manifest with multiple systemic clinical signs and symptoms, and digestive symptoms, such as nausea and vomiting, are most common in these patients. Moreover, the presence of a concurrent severe or rare complication may worsen the condition or even cause death due to misdiagnosis, delayed diagnosis, or inappropriate treatment. The identification of these symptoms is usually closely related to the severity and prognosis of the disease. Although clinical prognosis might be improved by prompt diagnosis and aggressive treatment, some rare and insidious metabolic complications are difficult to identify early. Moreover, life-threatening gastrointestinal symptoms are very rare in patients with DKA and TS. Here, we report an inpatient diagnosed with DKA and Graves’ disease who developed life-threatening intractable hiccups resulting in TS and respiratory failure during the treatment of DKA. In addition, we review the literature to discuss the possible underlying mechanism of intractable hiccups in the development of TS.

Hiccup is a prevalent event in the general population and can be found from milder, (so-called benign) to persistent and intractable forms. Hiccups have several causes, but stimulation of the phrenic nerve with compression, deformation and traction are among the most prevalent which could be consequence of mediastinal or lung cancer, gastric and/or esophageal distention, gastroesophageal reflux, instruments (catheters and intubation), cholecystitis, pericarditis or neurological causes. The objective of this paper is to stablish one treatment protocol and hiccup treatment in acute, persistent and intractable stages. A literature review was performed at Scielo, Pubmed, Ebsco, Clin Neuropharmacol, and ScienceDirect databases. Articles and publications from 1970 to 2015 were selected. The relevance of this article is the challenge for diagnostic and the difficulty to stablish the best plan to be addressed in cases of persistent or intractable hiccups in neurological patients, since they probably have many causes.

Introduction: Various causes of intractable hiccups have been reported; however, to the best of our knowledge, there are no previous reports of either intractable hiccups due to esophageal candidiasis in an immunocompetent adult or improvement following antifungal therapy. Case presentation: An 87-year-old man presented with intractable hiccups. Although the patient was immunocompetent, he used proton pump inhibitors. An esophagogastroduodenoscopy revealed several white deposits throughout the esophagus and extensive white deposits in the midesophageal diverticulum. A mucosal culture showed candidiasis, which was suspected to be the cause of the intractable hiccups. After oral fluconazole had been prescribed, the candidiasis resolved and the hiccups improved. Therefore, we concluded that esophageal diverticular candidiasis was the cause of his intractable hiccups. Conclusion: Physicians should consider esophageal candidiasis as one of the differential diagnoses for intractable hiccups, even in immunocompetent adults.

Background The authors report the case of a 34-year-old man who presented with intractable hiccups. The imaging examination showed that the patient was suffering from syringomyelia associated with Chiari type I malformation. Case Descriptions The patient underwent posterior fossa decompression combined with bilateral tonsillectomy and duroplasty. The intractable hiccups completely resolved 1 week after operation and had not recurred at 2 months after surgery. Postoperative magnetic resonance imaging showed the atrophy of the tonsils of the cerebellum and disappearance of the cavities of the spinal cord. Conclusions Intractable hiccups as the main symptoms of Chiari type I malformation are extremely rare in the clinic. Decompression surgery should be an appropriate method to relieve the symptoms.

Achalasia is an esophageal motility disorder of impaired lower esophageal sphincter relaxation and absent peristalsis. The presenting symptoms are commonly dysphagia, chest pain, regurgitation, and weight loss. Hiccups have been associated with gastrointestinal diseases but uncommonly associated with achalasia. We present a 62-year-old man with a history of dysphagia, weight loss, and intractable hiccups. High-resolution impedance manometry revealed Type I achalasia, which was treated with per oral endoscopic myotomy. Postoperatively, his dysphagia, weight loss, and intractable hiccups resolved.

Cardiac arrest may be accompanied with intractable hiccups and nausea or appear independently in patients with neuromyelitis optica spectrum disorder.

Increased intra-abdominal pressure (IAP) following large abdominal surgeries can lead to postoperative complications, including wound dehiscence and surgical reoperation. Numerous factors can contribute to increased postoperative IAP, and intractable hiccups have been implicated as a culprit. Different treatment modalities have been widely used with variable success in addressing intractable hiccups. Here, we present a case in which postoperative hiccups leading to wound dehiscence and reoperation were successfully treated with an indwelling phrenic nerve catheter. Following placement, a significant reduction in hiccup severity and frequency was noted, improving the patient's quality of postoperative course and preventing further surgical intervention.

Rationale: Hiccups are a common clinical symptom, and persistent hiccups and intractable hiccups severely impair the individual's quality of life. To date, there has been no effective treatment specifically for hiccups. Herein, we report 2 cases with intractable or persistent hiccups that were successfully treated with extracranial acupuncture. Patient concerns: The first case is a 46-year-old woman who presented with a 7-year history of intractable hiccups that had worsened over the past 3 years. She also complained of chest tightness, dyspnea, palpitations, dreaminess, dysphoria, intolerance of cold, and hypohidrosis. The second case is a 75-year-old man who presented with a 7-day history of persistent hiccups and hematemesis for 3 hours. The patient's persistent hiccups were treated using traditional Chinese acupuncture, but the patient reported no remarkable benefit. Diagnoses: They were diagnosed as intractable or persistent hiccups. Interventions: They were treated with extracranial acupuncture. Outcomes: The hiccups completely disappeared. During the follow-up period, the hiccups did not reappear. Lessons: According to neural balance theory, an episode of the hiccups is caused by an imbalance of the nervous system. Extracranial acupuncture in the area adjacent to the external occipital protuberance affects the intracranial nervous system, which can effectively control the hiccups. Our study provides a new approach to the treatment of hiccups.

Gangrenous cholecystitis (GC) is a serious complication of acute cholecystitis that has been associated with increased morbidity. Patient with GC can present with a wide variety of non-specific clinical, laboratory, and imaging characteristics, making the diagnosis challenging. This disease requires emergent treatment, which is why a quick and reliable diagnosis is essential for the wellbeing of the patient. The authors herein present a case of GC in a patient whose initial complaint was intractable hiccups, and provide a thorough review of the literature of cases of GC with atypical presentations.

Background Brain abscesses are well-known to neurologic surgeons with well-recognized presentations, which include seizures, neurologic deficit, and headache. Rare symptoms may lead to a delay in diagnosis, which can be life threatening in the setting of a brain abscess. Case Description We present the case of a 46-year-old male with intractable hiccups found to have an abscess of the right basal ganglia. The brain abscess was treated by frameless stereotactic-guided aspiration. The patient's hiccups improved after surgical aspiration and medical management. Conclusions A comprehensive literature review confirmed brain abscess as a rare cause of intractable hiccups. In addition, there are few reports of lesions of the basal ganglia causing intractable hiccups. Aspiration and medical therapy resulted in resolution of the hiccups. Knowledge of the hiccup reflex arc and unusual presentation of basal ganglia lesions may shorten time to diagnosis.

Intractable hiccupping is distressing for both patients under palliative care and their families, particularly if the patients have advanced cancer. The lack of clear management guidelines renders hiccup management challenging for health professionals. We report our management of intractable hiccups in a 70-year-old man with a progressive malignant brain tumour who was under palliative care. The hiccups were difficult to control; several drugs were tested before we finally introduced (and upwardly titrated) gabapentin, which appears to be safe when used to manage intractable hiccups.

In general, intractable hiccups are uncommon. Various drugs and interventions have been reported, but there is no consensus on the treatment of...

The frequency and clinical characteristics of intractable hiccups due to the medullary infarction is unknown. The aim of this study was to identify the lesions of hiccups using by brain MRI. Ninety acute medullary patients admitted to our stroke center within 14 days of stroke onset between April 2004 and August 2012 were retrospectively studied. We evaluated clinical characteristics and the frequency of the patients causing intractable hiccups among acute medullary stroke patients. We divided the patients into two groups, intractable hiccups group, and not hiccups group. Of 90 patients, five (5.5%) had intractable hiccups. Hiccups group had more frequently involved right middle medullary lesion than not hiccups group (hiccups group vs. not hiccups group; (60% vs. 4%, p < 0.001). In 16 cases reported the lesion of intractable hiccups, the right middle medullary lesion was 11 cases. We suspected that the lesion of the intractable hiccups was associated with the right middle medullary.

A 16 year old girl was evaluated for intractable hiccups for 6 six months, with a prior negative clinical and laboratory evaluation, and without any improvement with a variety of folk and medicinal therapies. A single treatment session of auriculotherapy produced a full clinical remission.

Hiccups are repeated involuntary, intermittent spasmodic contractions of the diaphragm and inspiratory intercostal muscles that results in sudden inspiration followed by a sudden closure of the glottis. It is naturally benign, self-limited but may be most of the time organic in nature and in some cases chronic, debilitating and psychogenic. Here we report a case of a 16 year old female student who developed hiccups of a psychogenic origin started by stress, which lasted for more than weeks sometime for a month and is successfully treated by antipsychotics haloperidol and psychological interventions. Physicians always face a diagnostic challenge, especially when no identifiable organic cause is elicited. However, such cases are invariably referred for psychiatric evaluation and treatment.

Objective To observe the therapeutic effect of scalp acupuncture combined with body acupuncture in treating cancer patients with intractable hiccups after radiochemotherapy.

Intractable hiccups can be a serious complication in transplant recipients. Unfortunately, many of the pharmacotherapies used to stop hiccups are associated with severe side effects as well as drug-drug interactions with immunosuppressants. We report a case of a heart transplant recipient who had had intractable hiccups for 2 months, resulting in severe insomnia, diminished appetite, and weight loss. To treat the hiccups, treatment with oral baclofen (5–10 mg 3 times daily) was started. After 6 weeks of therapy, the baclofen was titrated down and discontinued because it had not stopped the hiccups and was causing severe central nervous system side effects. Gabapentin (100 mg twice daily) was then prescribed and within 24 hours of the start of that treatment, the hiccups had resolved completely. After 3 weeks of therapy, the patient had no side effects and the gabapentin was subsequently discontinued. One year after stopping the gabapentin, the patient remains free of hiccups. Gabapentin appears to be a promising medication for the treatment of intractable hiccups in thoracic transplant recipients because of its lack of serious side effects at low doses, rapid onset of action, and lack of drug-drug interactions with transplant medications.

Supplemental Digital Content is available in the text, Rationale: Abdominal pain and hiccups secondary to intra-abdominal adhesion are surgical complications that are often treated by painkillers and secondary surgeries with an unsatisfactory therapeutic effect. This study presents a new treatment method that uses ultrasound-guided local infiltration in peritoneal and abdominal wall adhesions in patients with hiccups and abdominal pain. Patient concerns: A 62-year-old patient presented to our hospital with a history of intractable hiccups and abdominal pain for 30 years. Diagnoses: Her abdominal examination revealed a scar with an approximate length of 10 cm on the abdominal umbilical plane; pressing the right scar area could simultaneously induce abdominal pain and hiccups. Intraperitoneal computed tomography examination clearly demonstrated that the bowel had no obvious expansion. Ultrasonographic examination found that peritoneal motility below the normal peritoneal adhesion regions was significantly slower than in the normal regions. The diagnosis of chronic postoperative pain syndrome was clear. Interventions: The symptoms were significantly alleviated by a successful treatment with ultrasound-guided local infiltration in the peritoneal and abdominal wall scar adhesions. Outcomes: After 3 stages of hospitalization and 1 year of follow-up, the patient's abdominal wall pain was relieved by approximately 80% and hiccups were relieved by approximately 70%. Lessons: The above treatment is a useful option for managing abdominal adhesion and accompanying pain or hiccups resulting from abdominal surgery. This method could ease the psychological and economic burden of patients and improve their quality of life.

Hiccups are an involuntarily powerful spasm of the diaphragm, followed by a sudden inspiration with a closure of the glottis. Hiccups that are caused by gastric distention, spicy foods and neural dysfunction can resolve themselves without any treatment. Some hiccups are associated with certain diseases or they occur postsurgically, and life-restricting intractable hiccups should be treated. The cause of hiccups should be quickly determined so as to administer the proper treatment. Hiccups often remit spontaneously within a short period of time, but they may also occur without remission for a prolonged period in some cases. We report here on a 36-year-old man who suffered with intractable hiccups for 5 years. We administered a single oral dose of baclofen, and then the hiccups disappeared. We conclude that a single dose of baclofen is a good treatment for intractable hiccups.

Intractable nausea and vomiting along with hiccups is a commonly encountered problem on any general medicine or gastroenterology service. These symptoms are usually not appreciated as the possible initial manifestation of neuromyelitis optica (NMO). Missing diagnosis at this early stage will lead to a delay in the treatment, and hence, irreversible complications including blindness and paraplegia could occur. We report a case of a 22-year-old young female who presented with intractable hiccups and vomiting. After extensive evaluation, she was found to have NMO which involved the area postrema, the vomiting center of the brain. Early diagnosis from the clinical picture aided by aquaporin-4 serologic testing is extremely important to allow early initiation of immunosuppressive therapy. Immunosuppression gives an opportunity to modify the disease at an earlier stage rather than waiting for evolution of disease to fulfill the diagnostic criteria of NMO.Keywords: hiccups; vomiting; neuromyelitis optica; aquaporin-4 antibody; area postrema(Published: 19 October 2015)Citation: Journal of Community Hospital Internal Medicine Perspectives 2015, 5: 28850 - http://dx.doi.org/10.3402/jchimp.v5.28850

This is the third reported case of a posterior inferior cerebellar artery (PICA) aneurysm presenting as intractable hiccups (IH). A previously healthy 29-year-old woman was admitted with a 2-week history of hiccups occurring >100 times per minute. Symptoms persisted despite numerous noninvasive therapies. Magnetic resonance imaging and magnetic resonance angiogram of the brain showed a left PICA aneurysm that was confirmed by catheter angiography. Symptoms resolved following suboccipital craniotomy and resection. Although rare, PICA aneurysm is a potentially curable cause of IH.

Background Intractable hiccups are occasionally encountered in the presence of stroke but are usually difficult to manage. Methods We describe two stroke patients with intractable hiccups that were refractory to pharmacological treatment but were well resolved by application to relevant acupoints with the modality linear polarized near-infrared ray equipment on PC 6 (Nei Guan), ST 36 (Zu San Li), and DU 9 (Chih Yang), which are the empirical acupoints aimed at regulating gastrointestinal mobility and function of the thoracic organ. Results The first patient who received the treatment for only one time came out with a dramatic termination of intractable hiccups 3 hours later and with no recurrence thereafter. We applied the same treatment on the second patient once a day for 8 consecutive days, which led to progressive amelioration of intractable hiccups. Conclusions This is the first report about the complete resolution of intractable hiccups due to stroke using near-infrared irradiation to acupoints, rather than using conventional pharmacologic therapy, traditional acupuncture, or moxibustion. Consequently, these findings suggest that linear polarized near-infrared ray irradiation, with its noninvasive properties, might be an alternative treatment for intractable hiccups after stroke.

Hiccup is a sudden contraction of the inspiratory muscles, followed by an abrupt closure of the glottis, thus producing a characteristic sound. Hiccups serve no known physiologic function. Mostly, it is a benign symptom which terminates without treatment. Persistent and intractable hiccups may indicate various organic disorders. The treatment is based on the organic disorder, if it is found. Uremia in chronic renal failure is one of the causes of hiccups. We describe a case report with hiccups during peritoneal dialysis treated by termination of peritoneal dialysis. KEY wORdS: Peritoneal dialysis, Hiccups, Hemodialysis doi: 10.5262/tndt.2013.1001.20 Yazisma Adresi: Yener KOC Sisli Etfal Egitim ve Arastirma Hastanesi, Nefroloji Klinigi, Istanbul, Turkiye Gsm : 0 532 371 55 85 E-posta : dryenerkoc@mynet.com Gelis Tarihi : 26.05.2012 Kabul Tarihi : 11.07.2012 Kronik bobrek yetmezligi olan hastalarda yuksek serum ure duzeyinin frenik siniri uyarmasi nedeniyle sik sik gorulebilen hickirik genellikle kisa surelidir (6). Son donem bobrek yetmezligi tedavi seceneklerinden birisi olan periton diyalizinde (PD) batin ici basinc artisi ile bazen kisa sureli hickirik olabilir. Literaturde simdiye kadar inatci, tibbi tedaviye cevap vermedigi icin PD tedavisi sonlandirilan vaka sunumlari bildirilmemistir.

Supratentorial hiccup is a rare condition and no patients with persistent hiccups and chronic subdural hematoma have been reported. A 38-year-old man with intractable hiccups, headache, and nausea was admitted to our hospital. Computed tomography revealed a supratentorial chronic subdural hematoma on the left side. After burr hole surgery to remove the hematoma his hiccups disappeared immediately and he was discharged home on the 3rd postoperative day with no neurological deficits. Although the role of the supratentorial nervous system in hiccups is not clearly understood, supratentorial areas play an important role in the stimulation or suppression of the hiccup centers. Chronic hiccups may be a presenting symptom of chronic subdural hematoma attending headache with nausea if it has no gastrointestinal abnormality.

Second to pain control, gastrointestinal symptoms are one of the more common problems that healthcare professionals face when providing care at the end of life. These can range from mild and annoying to severe symptoms requiring emergency interventions. To treat these symptoms, individuals involved with the care of these patients must have a treatment plan based on a thorough assessment and an understanding of the underlying pathology. The following symptoms are reviewed: nausea and vomiting, dyspepsia and gastroesophageal reflux disease (GERD), constipation, hepaticrelated symptoms and intractable hiccups.