A report describes a case of a 50-year-old man who presented with a 5-month history of recurrent vomiting associated with nausea. He reported vomiting at least five times/day, which was non-projectile, usually of the color of the food eaten, and never bilious. He denied any history of abdominal pain, dysphagia, fever, or headache. His stools were of normal color, but he suffered constipation for six days before admission. The patient also reported weight loss, which could not be quantified.

He reported visiting several health facilities and receiving treatment with promethazine, but without any relief. His previous endoscopy report showed reflux oesophagitis and lax lower oesophageal sphincter. 

He received the diagnosis of type 2 diabetes mellitus two months ago and was prescribed glibenclamide but stopped as he felt it was making him vomit more, and he was now only taking metformin. He reported moderate alcohol consumption (< 20 units/week) but denied its consumption since the symptoms started. 

Examination revealed him to be moderately cachexia and dehydrated, with blood pressure (BP) of 130/80 mmHg, a temperature of 37oC, a pulse of 92/minute, and a respiratory rate of 28/minute.

Chest and abdominal examinations were normal except for the presence of hard stools in the rectum. Fundoscopy revealed dot and blot hemorrhages, consistent with background diabetic retinopathy.

His random blood glucose concentration was 252mg/dl, and without ketones in the urine. His Blood potassium and sodium were 3.1 mmol/L (3.6 – 5.0) and 127 mmol/L (135 – 145), respectively, with normal blood creatinine and no proteinuria.

His repeat endoscopy showed a normal esophagus and a long tubular stomach with a normal mucosal appearance, no food residue, normal duodenum to the second part, and no evidence of obstruction to that level.

Background retinopathy (a microvascular complication) in the patient implied the duration of undiagnosed diabetes of at least five years. On further inquiry, the patient admitted to having numb feet, erectile impotence, and dizziness on standing. Monofilament sensory testing revealed a sensory loss in both feet. He showed marked postural hypotension with a lying BP of 160/100mmHg and a standing BP of 120/80mmHg. This finding, together with the erectile impotence, indicated diabetic sensory and autonomic neuropathy (which was later confirmed by an autonomic function test).

The combination of typical, intractable symptoms of vomiting, with normal endoscopy and diabetic complications, including autonomic neuropathy, indicated diabetic gastroparesis.

The patient responded to domperidone 10 mg TDS and received a discharge. However, he presented again after only two weeks when he ran out of domperidone.

Segula D, Mwandiambira V, Howson W, Allain TJ. Case report--the 46-year-old man with a 5-month history of vomiting. Malawi Med J. 2011 Jun;23(2):55-7. doi: 10.4314/mmj.v23i2.70752. PMID: 23074813; PMCID: PMC3627695.