Larry Mellick, MD, MS, FAAP, FACEP
Professor of Emergency Medicine
Medical College of Georgia
Pearl: Large amounts of swallowed air (aerophagia) can compromise normal breathing.
Presentation: A law enforcement trainee presented in for evaluation of difficulty breathing following exposure to oleoresin capsicum (OC) spray. His face was flushed and his red eyes were described as "burning." (This training with pepper spray intends to give the trainees an appreciation for pepper spray and to generate a level of empathy for the criminals experiencing its effects…well at least part of this is true.) The young man was initially hyperventilating and reported difficulty breathing. On examination he was only able to speak in short sentences and had a very limited and brief inspiratory phase. His abdomen was tight and distended and his level of distress was significant. Only after being asked to assume the right lateral decubitus position was his obstructed breathing relieved. No further interventions were required. After a period of observation the patient returned to his training activities.
Discussion: This individual was experiencing a complication of aerophagia which is the swallowing of excessive amounts of air. The name itself is literally translated as "eating air." Various degrees of aerophagia are frequently observed in crying and distressed pediatric trauma patients. Other patients experience complications of chronic aerophagia. The chronic form of aerophagia is seen in institutionalized patients who are profoundly mentally retarded.1
A crying child can swallow air to the point that the stomach becomes severely distended. On examination the abdomen is so tight and distended that it appears to be an acute abdomen and the child appears to be in severe pain. The presentation can and often does stimulate an extensive and unnecessary trauma work-up. More importantly, the distended stomach can impede diaphragm movement and death from respiratory compromise or an acute abdomen can reportedly occur.2,3,4 This is one of the few situations where a nasogastric tube can save a life or at least make a patient feel more comfortable.
In the case of the law enforcement trainee, assuming the right lateral decubitus position relieved his respiratory distress and allowed him to expel the excess air with belching.
References:
- Holburn CS. Aerophagia: an uncommon form of self-injury. Am J Ment Defic. 1986 Sep;91(2):201-3.
- De Keulenaer BL, De Backer A, Schepens DR, Daelemans R, Wilmer A, Malbrain ML. Intensive Care Med. Abdominal compartment syndrome related to noninvasive ventilation. 2003 Jul;29(7):1177-81.
Epub 2003 May 22.
- Lalwani K. Aerophagia and anesthesia: an unusual cause of ventilatory insufficiency in a neonate.
Paediatr Anaesth. 2005 Oct;15(10):897-9.
- van der Kolk MB, Bender MH, Goris RJ. Acute abdomen in mentally retarded patients: role of aerophagia. Report of nine cases.
Eur J Surg. 1999 May;165(5):507-11.
|
