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Intractable hiccups are a rare yet debilitating pathology with a broad differential and often indicate a more serious underlying pathology, which can range from neoplasms to structural abnormalities. In this case report, we present a 64-year-old male with seven months of intractable hiccups determined to be caused by eventration of the right hemidiaphragm. The patient was treated with baclofen to treat the hiccups pharmacologically. He was also prescribed voice therapy to establish rescue breathing techniques and reduce laryngospasm. Finally, he was referred to thoracic surgery for further evaluation and potential surgical intervention should his diaphragmatic eventration worsen or cause hypoxemia. To our knowledge, this is the first reported case of an association between diaphragmatic eventration and intractable hiccups. It is important to highlight this addition to the broad differential of intractable hiccups and to emphasize an interdisciplinary approach to workup and treatment of intractable hiccups.

Abstract Background Hiccups (medically termed, “singultus”), when intractable, can cause significant medical consequences such as aspiration, malnutrition, and depression, leading to poor quality of life. Several case reports have shown that vagus nerve stimulator (VNS) implantation can help treat central idiopathic intractable hiccups. However, we present a contrary case of a patient who developed intractable singultus following VNS placement for medically refractory epilepsy. Case presentation We report a 71-year-old male patient with drug-resistant epilepsy who underwent VNS implantation and developed intractable hiccups shortly thereafter. The hiccups were severe and persistent, such that the patient developed a Mallory-Weiss tear, which required intensive care, invasive intubation and mechanical ventilation, and a prolonged rehabilitation course. Despite multiple therapies including phrenic nerve block and Nissen fundoplication, the patient’s hiccups persisted and only stopped once the VNS was permanently deactivated. Conclusions Little is known about the incidence of hiccups after VNS implantation. We present one case of hiccups as a direct consequence of VNS implantation. The clinical impact of this report is significant given the relative unfamiliarity of hiccups as an adverse effect of VNS implantation. Neurologists and epileptologists, who present VNS implantation as a surgical option for seizure control to their patients, should be aware of the possibility of singultus development and its significant physical and emotional ramifications.

Purpose of Review: Hiccups and belching are common physiological phenomena that involve air movement in the upper GI tract. Because of their commonplace and often acute nature, the problem of hiccups and belching is often trivialized. As a result, there is a dearth of high-quality original research on these topics. In this review, we will summarize the current understanding of epidemiological data, pathophysiological mechanisms, and therapeutic modalities of intractable hiccups and belching. Recent Findings: There has been little advancement in this particular area of gastroenterology beyond case reports and systematic reviews. Hiccups are involuntary contractions of the diaphragm combined with reflexive closure of the glottis. When hiccups last longer than 48 h, they are defined as persistent, and after a month, they become intractable. Hiccups occur when a lesion or irritant triggers the hiccup reflex arc, composed primarily of the midbrain, the phrenic nerve, and the vagus nerve. Non-pharmacological approaches like breath holding can be successful in terminating an acute episode. However, for persistent and intractable hiccups, identifying a specific etiology and initiating pharmacologic treatment, such as a proton pump inhibitor, baclofen, or gabapentin, become essential. Belching is the process of expelling gas from the upper digestive tract into the pharynx. Belching becomes pathological when it impacts usual activities for >3 days per week. It is divided into gastric and supragastric belching. Esophageal manometry with impedance testing is considered the gold standard in its diagnosis. An upper endoscopy is indicated if alarm symptoms are present. Management of belching includes avoiding carbonated beverages, eating slowly, stopping the use of tobacco, avoiding gum chewing, and treating gastroesophageal reflux. Baclofen can also be effective in gastric belching, while supragastric belching is often treated with behavioral modification techniques such as diaphragmatic breathing and speech and cognitive-behavioral therapies. Summary: Intractable hiccups and belching are common but poorly studied phenomena. When symptoms become persistent, patients' quality of life can diminish dramatically. Management hinges on identifying an etiology and, if one is identified, initiating targeted therapy. Otherwise, empiric treatment of GERD is often the first line, followed by baclofen as the second line. [ABSTRACT FROM AUTHOR]

Background: Hiccups (medically termed, "singultus"), when intractable, can cause significant medical consequences such as aspiration, malnutrition, and depression, leading to poor quality of life. Several case reports have shown that vagus nerve stimulator (VNS) implantation can help treat central idiopathic intractable hiccups. However, we present a contrary case of a patient who developed intractable singultus following VNS placement for medically refractory epilepsy. Case presentation: We report a 71-year-old male patient with drug-resistant epilepsy who underwent VNS implantation and developed intractable hiccups shortly thereafter. The hiccups were severe and persistent, such that the patient developed a Mallory-Weiss tear, which required intensive care, invasive intubation and mechanical ventilation, and a prolonged rehabilitation course. Despite multiple therapies including phrenic nerve block and Nissen fundoplication, the patient's hiccups persisted and only stopped once the VNS was permanently deactivated. Conclusions: Little is known about the incidence of hiccups after VNS implantation. We present one case of hiccups as a direct consequence of VNS implantation. The clinical impact of this report is significant given the relative unfamiliarity of hiccups as an adverse effect of VNS implantation. Neurologists and epileptologists, who present VNS implantation as a surgical option for seizure control to their patients, should be aware of the possibility of singultus development and its significant physical and emotional ramifications. [ABSTRACT FROM AUTHOR]

Acute optic neuritis (ON) is caused by variety of complex disorders that can be differentiated with the help of history, radiology, and serology. Identification of nonneurological symptoms that occur before the demyelinating event aids in timely diagnosis and prevention of further neurological attacks. We describe a case of unilateral ON with a history of intractable hiccups, nausea, and vomiting, wherein the possibility of area postrema syndrome (APS) was overlooked until the development of visual symptoms. APS recently identified as a hallmark of neuromyelitis optica spectrum disorder is a rare neurologic cause of gastrointestinal symptoms. This atypical presentation of APS results from autoantibodies directed against the aquaporin-4 rich sites, such as area postrema. This case brings to light the importance of eliciting history of intractable hiccups, nausea, and vomiting in a patient with ON. Despite being a commonly encountered symptom, it may rarely raise a suspicion for neuromyelitis optica.

Background: Spinal cord stimulation for the treatment of chronic refractory back pain is widely used and is associated with low risk. The onset of chronic debilitating hiccups following SCS implantation has not been previously reported. We describe a novel case of intractable hiccups following the placement of a thoracic epidural paddle electrode for the treatment of chronic back pain, and discuss the underlying pathophysiology of hiccups in association with SCS insertion. Case Description:: We describe a case of a 61-year-old male who presented with refractory chronic low back, coccygeal, and radicular lower extremity pain. A SCS trial provided 60 % improvement in pain, and therefore he underwent implantation of a 2x8 electrode epidural paddle lead spanning the T9 vertebral body. Post-operatively, the patient’s pain was improved, however he experienced new-onset involuntary abdominal spasms and hiccups. He underwent a comprehensive medical work-up, several SCS reprogramming trials, and revision surgeries. Abdominal spasms resolved; however, the hiccups insidiously worsened. At 3.5 years post-implantation, he reports ongoing adequate pain control but continues to experience debilitating, severe hiccups. Conclusions: This case illustrates a unique and unexpected outcome of new-onset intractable hiccups following placement of an epidural thoracic SCS lead. Whether this complication of SCS lead placement is consequent to aberrant stimulation of the hiccup reflex arc or injury to the thoracic spinal cord is not yet clear and may be elucidated by future research.

Acute optic neuritis (ON) is caused by variety of complex disorders that can be differentiated with the help of history, radiology, and serology. Identification of nonneurological symptoms that occur before the demyelinating event aids in timely diagnosis and prevention of further neurological attacks. We describe a case of unilateral ON with a history of intractable hiccups, nausea, and vomiting, wherein the possibility of area postrema syndrome (APS) was overlooked until the development of visual symptoms. APS recently identified as a hallmark of neuromyelitis optica spectrum disorder is a rare neurologic cause of gastrointestinal symptoms. This atypical presentation of APS results from autoantibodies directed against the aquaporin-4 rich sites, such as area postrema. This case brings to light the importance of eliciting history of intractable hiccups, nausea, and vomiting in a patient with ON. Despite being a commonly encountered symptom, it may rarely raise a suspicion for neuromyelitis optica. [ABSTRACT FROM AUTHOR]

Hiccups are usually self-limiting and benign but can be distressing when they become persistent or intractable and produce significant morbidity. In the intubated patients in neurocritical care, persistent hiccups may cause respiratory alkalosis and are also associated with an increased incidence of ventilator-associated pneumonia. Several pharmacological and nonpharmacological strategies have been devised for the treatment of persistent and intractable hiccups. The evidence to support or declare any intervention as harmful is scarce. In this review, we have presented the pathophysiology and workup, and a stepwise management protocol for intractable hiccups.

Hiccup has a wide variety of etiologies irritating the hiccup reflex arc. It is usually benign and self-limited but can be an alarm sign for serious underlying conditions. Hiccup has been rarely reported in patients with infective endocarditis as a result of splenic involvement and phrenic nerve irritation. Herein, we report a 72-year-old man with the chief complaint of long-lasting hiccups (for a 1-month duration) who was diagnosed with infective endocarditis; however, his spleen was grossly intact. The bouts of hiccups repeated 2-3 times a day and lasted for 10-20 minutes. After the initiation of antibiotics, his symptoms waned for a while and appeared again, and then, the hiccups were eliminated. Long-lasting hiccups can be a presentation of serious medical conditions such as infective endocarditis, with or without splenic involvement. Hence, it is important to keep in mind these conditions to perform proper diagnostic and therapeutic workups.

A 63-year-old man who presented to the hospital with altered mental status and decreased responsiveness was found to have severe symptomatic hyponatremia with a sodium level of 96 mmol/L and pneumonia. The patient was admitted to the medical intensive care unit for septic shock and acute severe hyponatremia. He was intubated for airway protection, and treated with 3% hypertonic saline bolus and antibiotics. After four days, sodium levels were corrected to 128 mmol/L, and the patient was extubated and downgraded to the medical floor. This case demonstrates one of the lowest recorded sodium lab values ever and the patient was successfully treated and discharged home with appropriate outpatient appointments., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Mandhan et al.)

Hiccups, a common and usually self-limiting condition, are caused by involuntary, spasmodic contractions of the diaphragm and intercostal muscles, followed by the sudden closure of the glottis. While most cases resolve spontaneously, persistent hiccups (lasting 48 hours to one month) and intractable hiccups (lasting more than one month) require medical attention. Intractable hiccups, although rare, can significantly impair a patient's quality of life. The etiology of intractable hiccups is diverse, but they are often associated with serious underlying medical conditions, such as severe renal dysfunction and uremia. We present the case of a 72-year-old male patient with stage IV chronic kidney disease (CKD) who developed intractable, violent hiccups following a mild COVID-19 infection. Despite treatment attempts with chlorpromazine and baclofen, the hiccups persisted for five months and only resolved after the initiation of hemodialysis. Interestingly, the patient's renal function deteriorated significantly during the period of hiccup persistence, suggesting a possible link between the hiccups and the progression of CKD, likely exacerbated by COVID-19. This case highlights the challenges of managing intractable hiccups in patients with advanced CKD and emphasizes the importance of addressing underlying metabolic derangements in such complex clinical scenarios. Moreover, it contributes to the growing evidence supporting the role of dialysis in resolving intractable hiccups associated with severe renal dysfunction., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Minoretti et al.)

Introduction Hiccups are an involuntarily powerful spasm of the diaphragm, followed by a sudden inspiration with a closure of the glottis. Hiccups lasting longer than one month is termed intractable hiccups. Intractable hiccups can be caused by structural or functional disturbances of the medulla, afferent or efferent nerves to the respiratory muscles or metabolic and endocrine disorders, drugs, general anaesthesia and emotional problems. Objectives Authors present a case report about curing a patient of intractable hiccups using baclofen along with literature review. Methods A case report along with literature review forms the basis of discussion. Results A 30-year female diagnosed with schizophrenia stable on 2mg risperidone for 3 years presented to the outpatient department with complain of intractable hiccups for 6 months. Frequency of hiccups was around 10-12 times per minute and continued throughout the day leading to significant socio-occupational distress. patient had been receiving medical treatment for last 4 months for the same including Metoclopramide, chlorpromazine along with trying breath holding and drinking cold water but symptoms persisted. Her ECG, chest X-ray, complete blood counts were unremarkable, CT scan of brain was normal. Patient was started on baclofen 10mg thrice daily. Within 1-week patient had dramatic response and complete remission was achieved in 2 weeks. Conclusions Beclofen is effective in hiccups because it is an analogue of GABA, that decreases excitability and inhibits the hiccup reflex, which reduces synaptic transmission. Baclofen is used to treat hiccups, and can be used either as a first-line treatment or if patient does not respond to other medications. Disclosure No significant relationships.

Hiccup has a wide variety of etiologies irritating the hiccup reflex arc. It is usually benign and self-limited but can be an alarm sign for serious underlying conditions. Hiccup has been rarely reported in patients with infective endocarditis as a result of splenic involvement and phrenic nerve irritation. Herein, we report a 72-year-old man with the chief complaint of long-lasting hiccups (for a 1-month duration) who was diagnosed with infective endocarditis; however, his spleen was grossly intact. The bouts of hiccups repeated 2-3 times a day and lasted for 10- 20 minutes. After the initiation of antibiotics, his symptoms waned for a while and appeared again, and then, the hiccups were eliminated. Long-lasting hiccups can be a presentation of serious medical conditions such as infective endocarditis, with or without splenic involvement. Hence, it is important to keep in mind these conditions to perform proper diagnostic and therapeutic workups. [ABSTRACT FROM AUTHOR]

• Intractable hiccups are associated with significant morbidity and may lead to mortality. • Several medical, pharmacological, surgical and novel treatment options are available. • Vagus nerve stimulator placement is a novel surgical option for the treatment of intractable hiccups. • Vagus nerve stimulator is currently not approved for the indication of intractable hiccups. Intractable hiccups frequently result from an underlying pathology and can cause considerable illness in the patients. Initial remedies such as drinking cold water, induction of emesis, carotid sinus massage or Valsalva manoeuvre all seem to work by over stimulating the Vagus nerve. Pharmacotherapy with baclofen, gabapentin and other centrally and peripherally acting agents such as chlorpromazine and metoclopramide are reserved as second line treatment. Medical refractory cases even indulge in unconventional therapies such as hypnosis, massages and acupuncture. Surgical intervention, although undertaken very rarely, predominantly revolves around phrenic nerve crushing, blockade or pacing. A novel surgical strategy is emerging in the form of Vagus nerve stimulator (VNS) placement with three cases cited in literature to date with varying degrees of success. Here the authors report a case of VNS placement for intractable hiccups with partial success, in accordance with SCARE-2018 guidelines. An 85-year-old gentleman with a 9-year history of intractable hiccups secondary to pneumonia came to our hospital. The hiccups were symptomatic causing anorexia, insomnia, irritability, depression, exhaustion, muscle wasting and weight loss. The patient underwent countless medical evaluations. All examinations and investigations yielded normal results. The patient underwent aggressive pharmacotherapy, home remedies and unconventional therapies for intractable hiccups but to no avail. He also underwent left phrenic nerve blocking and resection without therapeutic success. The patient presented to our hospital and decision for VNS insertion was taken for compassionate reasons considering patient morbidity. The patient demonstrated significant improvement in his symptoms following VNS insertion. A temporary hiccup is an occasional happening experienced by everyone. However, intractable hiccups are associated with significant morbidity and often mortality. Several medical, pharmacological, surgical and novel treatment options are available for intractable hiccups. VNS insertion is a novel surgical option for the treatment of intractable hiccups. [ABSTRACT FROM AUTHOR]

Background: Intractable hiccups can last for more than 1-2 months and can occur, as shown in this case study, due to cervical nerve root compression. Background: Intractable hiccups can last for more than 1-2 months and can occur, as shown in this case study, due to cervical nerve root compression. Conclusion: A 76-year-old male presented with intractable hiccups and neck pain attributed to a left C3/C4 lateral/foraminal spondylotic ridge. Following a left C3-C4 laminoforaminotomy, the frequency of hiccup attacks remained the same, but their duration was markedly shortened to 30 s, while the neck pain improved. [ABSTRACT FROM AUTHOR]

Hiccups are a well-known short-term phenomenon in daily life. If they persist or become intractable, they may be a primary symptom of a disease. Recent studies identified the medulla oblongata as the neuroanatomic center of the hiccup reflex arc. In previous cases, an isolated lesion at the dorsal side of the medulla oblongata induced intractable hiccups. We herein describe a patient with a perimedullary arteriovenous fistula (PMAVF) at the craniocervical junction who had intractable hiccups. A 70-year-old male presented with a 3-year history of intractable hiccups that continued for a few days every week. An initial examination failed to identify the underlying cause, and neither medicine nor self-treatment attenuated his symptoms. Intracranial T2-weighted magnetic resonance imaging showed a hyperintensity area within the dorsolateral medulla and flow voids along the dorsal side of the cervical spine. Angiography revealed PMAVF fed by the left C1 radiculomedullary artery. Obliteration of the fistula was performed, after which intractable hiccups had completely disappeared within 1 week. This is the first case report of PMAVF at the craniocervical junction presenting with intractable hiccups that suggested a lesion in the dorsal side of the medulla. The mechanisms underlying hiccups are also discussed. [ABSTRACT FROM AUTHOR]

• 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. 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. 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. 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. Giant hydronephrosis can present rare symptoms as "intractable hiccups". The selection of treatment should be made depending on the cause. [ABSTRACT FROM AUTHOR]

Shinsuke Yahata,1,2 Tsuneaki Kenzaka,1 Saeko Kushida,3 Hogara Nishisaki,2 Hozuka Akita2 1Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, 2Department of Internal Medicine, Hyogo Prefectural Kaibara Hospital, Tamba, 3Department of Gastroenterological Oncology, Hyogo Cancer Center, Akashi, Japan 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. Keywords: Intractable hiccups, candidiasis, esophageal diverticulum, immunocompetence, elderly, acid-suppression therapy

Background Hiccups are a common physiologic reflex resulting from intermittent and involuntary spasmodic contraction of the diaphragm and intercostal muscles. While most cases are self-limited, lasting less than 48 hours, rare pathologies may result in prolonged symptoms. Hiccups can be disruptive and uncomfortable, leading many to seek management strategies using common home remedies. Few methods for terminating hiccups have been published in the scientific literature. We report the efficacy of the Hiccup relief using Active Prolonged Inspiration (HAPI) technique, which combines phrenic and vagal nerve stimulation with transient hypercapnia for hiccup relief. Methods Twenty patients with self-limited hiccups and one patient with prolonged hiccups were successful in eliminating hiccups using HAPI. In this method, patients are instructed to inspire maximally. Once at the peak of inspiration, they continue to attempt to inspire with an open glottis for a total of 30 seconds. This is followed by a slow expiration and resumption of normal respiration. Results In all cases, patients reported immediate hiccup relief. Conclusion These findings suggest the HAPI technique is a simple and viable method for hiccup relief. Further studies are needed to validate effectiveness., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Stacey et al.)

In this topical review, we discuss the history of the area postrema syndrome, with special attention given to early studies aimed at identifying the area postrema and its function, possible early cases of the syndrome and its current relevance in neuroimmunology and demyelinating diseases. In 1896, Retzius named a structure in the posterior medulla oblongata as the area postrema. The work of Borison in the middle of the 20th century led to the elucidation of its function as a "vomiting center." The historical medical literature is filled with excellent examples that could be described as "area postrema syndrome." While severe and bilateral optic neuritis and transverse myelitis still constitute the classic components of neuromyelitis optica spectrum disorder (NMOSD), intractable vomiting and hiccups due to area postrema involvement is now recognized as essentially pathognomonic, indeed a shiny pearl in neuroimmunology and demyelinating diseases. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Postoperative intractable hiccups slow patient recovery and generate multiple adverse effects, highlighting the importance of investigating the pathogenesis and terminating the hiccups in a timely manner. At present, medical and physical therapies account for the main treatments. We encountered a case in which postoperative intractable hiccups after biliary T-tube drainage removal ceased with the application of an ultrasound-guided block of the unilateral phrenic nerve and stellate ganglion. No complications developed, and the therapeutic effect was remarkable. To our knowledge, this approach has not been reported to date. Simultaneously blocking the phrenic nerve and stellate ganglion may be a treatment option for intractable hiccups.

Singultus is the sudden onset of erratic diaphragmatic and intercostal muscle contraction immediately followed by laryngeal closure. Pathophysiology involves afferent, central and efferent components. Bilateral phrenic nerve block was performed to a 46-year-old woman with a brain tumor with persistent hiccups, with initially positive response but later symptom recurrence. Bilateral pulsed radiofrequency of the phrenic nerve was performed guided by ultrasonography (US). In the follow-up, absence of hiccups was confirmed. The patient was discharged 24 h later. Persistent or untreatable singultus is an infrequent condition that should not be dismissed. This approach is a safe, accurate and effective therapeutic approach for patient's refractory to conservative treatment. Further studies are needed to establish safety and effectiveness of the treatment.

Abstract 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 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. Highlights • Intractable hiccups are a rare symptom of Chiari type I malformation. • We reported a patient with Chiari type I malformation who suffered from intractable hiccups. • When intractable hiccups occurred, we scheduled an MRI examination to exclude Chiari type I malformation. • Decompressive surgery can significantly alleviate intractable hiccups caused by Chiari type I malformation. [ABSTRACT FROM AUTHOR]