Abstract
A 37-year-old man was diagnosed with suspected Crohn’s disease based on clinical history, although a definitive pathological diagnosis could not be made. He was initially admitted to a local hospital due to postprandial vomiting and frequent diarrhea, and was later transferred to our hospital for further treatment. The patient also had a developmental disorder that made it difficult for him to comply with medical instructions, including fasting instructions during treatment. Consequently, the patient developed perforated peritonitis and underwent emergency surgery for stoma construction. Following extubation after surgery, his respiratory condition worsened due to aspiration pneumonia, requiring repeated reintubation and eventually tracheostomy. Postoperatively, he developed sarcopenic dysphagia, likely due to surgical stress, physical inactivity, and malnutrition. Videofluoroscopic swallowing examination revealed pharyngeal residues and aspiration. Conventional swallowing rehabilitation techniques―such as head-raising exercises, mouth-opening exercises, and tongue resistance training―were difficult to apply due to his strong behavioral rigidity, impaired comprehension, and low endurance associated with his developmental disorder. Therefore, we implemented a swallowing training program that incorporated neuromuscular electrical stimulation (NMES) to repeatedly trigger the swallowing reflex. This approach led to improved swallowing function, and the patient was eventually able to resume normal oral intake. This case suggests the potential effectiveness of NMES-assisted therapy for patients with sarcopenic dysphagia, particularly those with limited compliance. A brief literature review was conducted to support this study.
