Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Mar 16, 2023; 11(8): 1862-1868
Published online Mar 16, 2023. doi: 10.12998/wjcc.v11.i8.1862
Gastroparesis after video-assisted thoracic surgery: A case report
Hang An, Yu-Cun Liu
Hang An, Yu-Cun Liu, Department of General Surgery, Peking University First Hospital, Beijing 100034, China
Author contributions: An H contributed to manuscript writing and editing and data collection; Liu YC contributed to conceptualization and supervision; all authors have read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yu-Cun Liu, MD, Professor, Department of General Surgery, Peking University First Hospital, No. 8 Xishiku Street, Beijing 100034, China. 2011110327@bjmu.edu.cn
Received: January 7, 2023
Peer-review started: January 7, 2023
First decision: January 17, 2023
Revised: January 19, 2023
Accepted: February 21, 2023
Article in press: February 21, 2023
Published online: March 16, 2023
Processing time: 58 Days and 23 Hours
Abstract
BACKGROUND

Video-assisted thoracic surgery (VATS) lobectomy is a common treatment for patients with early-stage lung cancer. Some patients can experience slight gastrointestinal discomfort after lobectomy for a moment. Gastroparesis is a gastrointestinal disorder that can be severe; it is associated with an increased risk of aspiration pneumonia and impaired postoperative recovery. Here, we report a rare case of gastroparesis after VATS lobectomy.

CASE SUMMARY

A 61-year-old man underwent VATS right lower lobectomy uneventfully but had an obstruction of the upper digestive tract 2 d after surgery. Acute gastroparesis was diagnosed after emergency computed tomography and oral iohexol X-ray imaging. After gastrointestinal decompression and administration of prokinetic drugs, the patient’s gastrointestinal symptoms improved. Since perioperative medication was applied according to the recommended dose and there was no evidence of electrolyte imbalance, intraoperative periesophageal vagal nerve injury was the most likely underlying cause of gastroparesis.

CONCLUSION

Although gastroparesis is a rare perioperative complication following VATS, clinicians should be on the alert when patients complain about gastrointestinal discomfort. When surgeons resect paraesophageal lymph nodes with electrocautery, excessive ambient heat and compression of paraesophageal hematoma might induce vagal nerve dysfunction.

Keywords: Gastroparesis; Delayed gastrointestinal emptying; Video-assisted thoracic surgery; Lobectomy; Thoracic surgery; Case report

Core Tip: While postoperative gastroparesis is quite common in patients undergoing vagotomy for peptic ulcers and pylorus-sparing pancreatoduodenectomy, there are few reports following lobectomy. We report a rare case of gastroparesis after video-assisted thoracoscopic surgery. Since there was no evidence of drug-induced or electrocyte disorder-related gastrointestinal dysfunction, intraoperative periesophageal vagal nerve injury was most likely to account for gastroparesis. Clinicians should keep in mind that there is a potential possibility of vagal nerve injury after thoracic surgery even without direct nerve operation. For patients suffering gastroparesis after video-assisted thoracic surgery, conservative treatment, including gastrointestinal decompression and prokinetic medicines, can help relieve symptoms.