Yamac Erhan ( Departments of Surgery, Aegean University Medical School, Izmir, Turkey. )
Ali Koyuncu ( Departments of Surgery, Aegean University Medical School, Izmir, Turkey. )
Necla Osmanoglu ( Departments of Gastroenterology, Aegean University Medical School, Izmir, Turkey. )
Autonomic symptoms such as orthostatic hypotension, abnormal sweating and constipation occur frequently in Parkinson’s disease. In our case, barium meal used for upper gastrointestinal study caused barium stone formation and a paralytic-ileus-like syndrome. Therefore, attention should be paid while using barium meal for diagnostic purpose in Parkrnsonism.
Barium meal used in Parkinson’s disease for upper gastrointestinal tract studies can cause a real chaos. Autonomic symptoms such as orthostatic hypotension and abnormal sweating occur frequently in patients with idiopathic Parkinson’s disease1,2. Sialorrhea, nasopharyngeal dysfunction, dysphagia, achalasia delayed gastric emptying, chronic colonic pseudoobstruction, volvulus and megasigmoid are otherzdisturbances of alimentary function which have been reported by various authors3,4. In a significant number of cases, examination performed by barium enema revealed atony of the large bowel, sometimes leading to a megacolon5. Inpatients suffering from constipation with Parkinson\\\'s disease, barium meal used for upper gastrointestinal X-ray studies and barium enema should be immediately evacuated from the intestine in order to prevent the formation of barium stones7. We present a patient in whom barium meal caused a paralytic-ileus-like syndrome two days after an upper gastrointestinal series.
Autonomic symptoms, especially related with alimentary function, occur frequently in patients with idiopathic Parkinson\\\'s disease4,5. However, the distinct pathologic basis for autonomic symptoms in Parkinsonism has not been established. Some investigators have found degenerative changes, including neurons containing intracytoplasmic hyaline inclusions (Lewy bodies) in hypothalamic and brain stern nuclear gmups and in sympathetic ganglion cells in Paikinsonian patients with these symptoms and have concluded that the symptoms may reflect direct involvement of these neural structures by the disease process4,7. Involvement of the dorsal motor nucleus of the vagus nerve has been postulated to account in part for the disturbances in gastrointestinal func tion. Our case suggests that barium meal used in an upper gastrointestinal study may lead to the development of a paralytic-ileus-like syndrome in Parkinsonian patients with constipation.
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