1016 - Gastroparesis in a Traumatic Brain Injury Patient with CREST Syndrome

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

TD

Tava DeQuattro, DO

Resident
Mount Sinai Icahn School of Medicine
New York, New York, United States

Co-Author(s)

MA

Megan Andrews, MD

Attending Physician
Icahn School of Medicine at Mount Sinai
New York, New York, United States

Submitter(s)

TD

Tava DeQuattro, DO

Mount Sinai Icahn School of Medicine
New York, New York, United States

Case Diagnosis: Refractory vomiting in TBI

Case Description: A 55-year-old female with a history of CREST syndrome presented after a fall. She underwent emergent decompressive hemicraniectomy for subdural hematoma with post-operative course complicated by intracranial hemorrhage requiring extension of craniectomy. She was admitted to acute inpatient rehabilitation after PEG tube placement with initial tolerance of tube feeds followed by development of nausea and vomiting. Abdominal imaging raised concern for constipation without evidence of obstruction. Head CT was stable to prior studies. Infectious workup was negative. Despite aggressive bowel regimen, discontinuation of constipating medications, and tube feed adjustment, nausea and vomiting persisted. Though the differential for vomiting is broad, gastroparesis was suspected.

Discussions: Nutritional status in traumatic brain injury (TBI) patients is affected by nutrient intake, pathophysiologic changes, abnormalities in energy expenditure, and medication management. Gastroparesis, delayed gastric emptying in the absence of mechanical obstruction, is a potential sequela of TBI. More than 50% of TBI patients do not tolerate enteral feeding. The pathophysiology is poorly understood, though likely related to the negative impact of brain injury on the autonomic and enteric nervous systems. Additionally, TBI creates a systemic immune-inflammatory response which, chronically, can have deleterious effects on the gastrointestinal system. In this case, gastroparesis may be exacerbated by the patient’s pre-existing autoimmune disorder. Gastroparesis presents as nausea, vomiting, pain, early satiety, and bloating. Radiographic evaluation of the gastric emptying of solids with scintigraphy is the gold standard for diagnosis. First-line treatment consists of prokinetic agents, such as metoclopramide.

Conclusions: Intolerance of enteral feeding is a common phenomenon in TBI patients. Persistent nausea and vomiting in the absence of obstruction should prompt consideration of gastroparesis. In this patient, pre-existing autoimmune disorder in addition to brain injury and immobility during acute hospitalization made gastroparesis a likely diagnosis. Rehab can play a role in improving mobility and gastric motility.