Hiccups: A Subtle Sign in the Clinical Diagnosis of Gastric Volvulus and a Review of the Literature

Excerpt

Hiccups are defined as sudden, involuntary, spasmodic contractions of the diaphragm and external intercostal muscles that result in inspiration abruptly ending with the closure of the glottis [1]. The innervation of the hiccup reflex includes an afferent pathway via the vagus, phrenic, and sympathetic branches of T6–T12 and the efferent pathway via the phrenic nerve to the diaphragm, glottis, and external intercostal muscles [1]. The etiologies of hiccups are many, and over 100 have been reported in past reviews [2]. Some of the more common causes include luminal distention of the esophagus and stomach, irritative stimuli such as gastroesophageal reflux disease (GERD), pathologic conditions of the central nervous system (CNS), and metabolic abnormalities such as uremia [3]. We report on two cases where patients with gastric volvulus had hiccups as their presenting symptom. …