Persistent hiccup and pneumomediastinum: a rare clinical presentation

Abstract

Introduction: Persistent hiccup is an uncommon symptom that may be associated with a wide range of etiologies, including gastrointestinal, neurological, metabolic, and thoracic disorders. Spontaneous pneumomediastinum is a rare and usually benign condition that may occasionally present with atypical clinical manifestations. Case Report: A 24-year-old male was referred to our institution with a 15-day history of severe persistent hiccup associated with nausea and recurrent food-content vomiting. Physical examination revealed palpable cervical subcutaneous emphysema. Computed tomography demonstrated extensive pneumomediastinum involving the superior, middle, and inferior mediastinum, associated with a small pneumopericardium, without evidence of esophageal perforation. Upper gastrointestinal endoscopy revealed Los Angeles grade D erosive esophagitis and a large sliding hiatal hernia. Conservative management consisting of proton pump inhibitors, symptomatic treatment, and clinical observation was implemented, resulting in progressive resolution of symptoms and complete recovery. Conclusion: Persistent hiccup should prompt a comprehensive diagnostic evaluation, including thoracic and esophageal causes. The coexistence of spontaneous pneumomediastinum, severe erosive esophagitis, and hiatal hernia may have contributed to the clinical presentation observed in this patient. Early recognition of these conditions allows appropriate management and may prevent unnecessary invasive procedures.