ENTEROPARESIS DUE TO PROGRESSIVE FIBROSIS OF THE MUSCULARIS PROPRIA

We would like to present the case of a 54-year-old patient who was adm itted to the hospital with complaints of recurrent vomitus after food intake and associated weight loss. Endoscopy barium X-ray of the small bowel and scintigraphy showed enteroparesis. Full-thickness biopsies achieved by explorative laparotomy revealed the pathological changes. The inner circular muscular layer was atrophic and replaced by fibrosi s. The pathological findings were consistened with either visceral myo pathy or isolated intestinal progressive systemic sclerosis. A sporadi c nonfamilial type of visceral myopathy seems to be the most likely di agnosis in this case. Progressive systemic sclerosis seems to be unlik ely as the patient presented with isolated gastrointestinal involvemen t and lack of appropriate autoantibodies. The diseases progression mad e an enteral supplementation impossible. Therefore a parenteral nutrit ion was started, which was characterized by a complicated clinical cou rse. Persisting gastrointestinal complaints, recurrent port infections and lack of perspectives led to patient's diminished motivation for a dequate sterile use of the port-system. This case report shows that be sides the use of modern port-systems and antibiotics the psychologica l situation of patients treated with total parenteral nutrition is of great interest for optimal patient care.