Coalescent Cyclical Vomiting: A Manifestation of Narcotic Bowel Syndrome?
A 35 year-old man presented with an acute exacerbation of chronic abdominal pain,
Nausea and Vomiting (N&V). The pain was severe, unrelenting and affected the entire abdomen with an epicenter in the Left Lower Quadrant (LLQ). He also experienced vomiting every
15-20 minutes. After several episodes of emesis, he had noticed sharp and then continuing pain
in the center of the chest.
He had a long history of sudden episodes of abdominal pain, starting at the age of
twenty. Initially, he had suffered from a sudden onset of pain associated with nausea and vomiting with a frequency of more than 20 times per day. Typically, such episodes woke him up in
the early morning hours, persisted for several hours and eventually led to dehydration, requiring emergency room visits and even repeated hospitalizations. He could often alleviate milder
symptoms by taking hot showers or baths. Emetic episodes lasted for up to one week and were
followed by prolonged asymptomatic periods. However, his symptoms gradually progressed.
Eventually, he received chronic opioid therapy for the recurrent pain, which was associated
with an even more significant rise in the frequency of exacerbations. He had previously been
diagnosed as suffering from irritable bowel syndrome, anxiety and depression. During the 6
years prior to his current presentation, he had undergone more than 20 abdominal computerized
tomographies and ten upper endoscopies, which had all shown varying degrees of esophagitis
or occasional Mallory Weiss tears. Additional diagnostic studies had excluded pancreatic disease, hereditary angioedema, porphyria, gastroparesis, and small bowel or colonic disease.
Gastro Open J. 2015; 1(5): 111-113. doi: 10.17140/GOJ-1-119