P4508 - An Unusual and Challenging Case of Dysphagia and Dysphonia after ERCP: A Case of Tapia’s Syndrome

Shahryar Khan, MD¹, Yousaf Zafar, MD², Mashal Alam Khan, MBBS³, Azzah Muhammad Hayat, MBBS⁴, Hoor Umar Afridi, MBBS^5
1University of Kansas, Overland Park, KS; ²University of Mississippi Medical Center, Madison, MS; ³Khyber Medical University, Overland Park, KS; ⁴Khyber Medical University, Peshawar, North-West Frontier, Pakistan; ⁵Khyber Girls Medical College, Peshawar, North-West Frontier, Pakistan

Introduction: Tapia’s syndrome is a rare disease characterized by concurrent unilateral hypoglossal and recurrent laryngeal nerve palsy. Mechanism of the injury is likely related to airway manipulation leading to direct compression or excessive stretch of the nerves. It is usually a complication related to anesthesia and positioning of the head of the patient during surgery. Other causes are tumors, trauma to the upper neck and operations in the head, and neck region. The most common clinical symptoms are hoarseness of voice, difficulty in tongue movement, lingual motility disturbance, and dysphagia. Indeed, we did not find any cases with patients undergoing ERCP complicating with rare Tapia’s syndrome. Therefore, we present this care report on the incidence of this serious complication and management.

Case Description/Methods: A 57-year-old male with past medical history of Hypertension, Diabetes, Cholelithiasis status post Laparoscopic Cholecystectomy complicated with biliary duct disruption underwent ERCP for repair of a bile leak. General Anesthesia was uneventful with an atraumatic intubation and ERCP. Next day of his procedure, patient started complaining of difficulty with swallowing and sudden voice changes. Speech therapy was consulted, on their evaluation and video swallow assessment showed findings concerning for aspiration. ENT was consulted and Flexible Fiberoptic exam showed left vocal cord paresis with incomplete glottic closure. He had CT Neck and Chest to look for any organic cause of symptoms which were negative. MRI of the Brain was done to rule out central cause which was negative. Eventually, he underwent Left vocal cord augmentation with micro- laryngoscopy which helped with his voice. He received aggressive rehabilitation for swallowing and speech.

Discussion: Looking in literature, the incidence of this disorder might be underestimated and in fact, in the mild forms, symptoms can be confused with discomfort triggered by procedure. Diagnosis is made through exclusion and can be challenging for clinicians due to its relative infrequency. It is important to make a timely diagnosis so treatment and rehabilitation can be started early to achieve a good long-term outcome. Most studies have emphasized that the recovery of nerve function is usually completed within 6 months, and it is not always reversible. The mainstay of treatment in Tapia’s syndrome is a proper swallowing rehabilitation program. A multidisciplinary approach is required for correct management of this rare entity.


Disclosures:


Shahryar Khan, MD¹, Yousaf Zafar, MD², Mashal Alam Khan, MBBS³, Azzah Muhammad Hayat, MBBS⁴, Hoor Umar Afridi, MBBS⁵. P4508 - An Unusual and Challenging Case of Dysphagia and Dysphonia after ERCP: A Case of Tapia’s Syndrome, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.