An 80-year-old woman with a 5-year history of hypertension, optic neuritis and progressive bulbar paralysis.
She was admitted to the emergency department due to an episode of sudden dyspnoea after eating.
Your child says that for a long time has had repeated episodes and increasingly frequent cough in relation to fluid intake.
In the last trimester she also had difficulties in the intake of solids with increased salivary secretions.
Episodes of desaturation (8990%), with dyspnea and abundant noise of secretions on pulmonary auscultation were observed in the emergency department.
She was admitted to the Internal Medicine Department of the Hospital with a diagnosis of aspiration secondary to dysphagia.
Initial laboratory data revealed a normal blood count with a hemoglobin of 14.1 g/dl, in addition to normal coagulation.
Chest X-ray showed no infiltrates.
Upon admission and to avoid new episodes of bronchoaspiration, a nasogastric tube was performed, requesting gastrostomy in a programmed manner after stabilizing and seeing the patient's evolution.
She was treated with amoxicillin-clavulanic acid, bronchodilators and antibiotic therapy with good response.
During hospitalization, gastrostomy was performed, apparently without complications, although in the following hours there was periprosthetic bleeding and no hemostatic remains were obtained in the lavage.
Analytical tests were requested, showing significant anemization (Hb: 6.7 g/dl, previous Hb 14.1 g/dl), abdominal CT was performed showing the presence and extent of an abdominal wall hematoma.
We proceeded to change the gastrostomy tube, cleaning the perisonde zone and parenteral nutrition was initiated after placement of a PICC.
The patient required transfusion of 2 units of catheters, progressing favorably.
Before discharge, enteral nutrition was initiated through the gastrostomy, which tolerated without complications.
