A 26-year-old woman with an eating disorder presented to the emergency department with severe abdominal pain following binge eating. A plain film X-ray demonstrated a huge dilatation of the stomach with a high air-fluid level. Serum amylase was 2,265 IU/L, and serum lipase was 2,001 IU/L. Abdominopelvic computed tomography scan revealed a massive gastric dilatation and completely compressed duodenum. The distended right colonic loop and small bowel loops were reduced to the pelvic area and the displaced small bowel and mesenteries tightly pulled on the mesenteric vasculature. After nasogastric tube decompression and irrigation, her abdominal pain subsided. On the 15th day after admission, a follow-up abdominopelvic computed tomography scan demonstrated mild edematous changes of the pancreas compatible with pancreatitis.

Superior mesenteric artery (SMA) syndrome is a rare disorder, characterized by compression of the third segment of the duodenum by the mesenteric artery at the level of the SMA, resulting in duodenal dilatation. Precipitating factors of the SMA syndrome include prolonged bed rest, weight loss, abdominal surgery, and increased lordosis of the spine. We report a case of SMA syndrome caused by anorexia nervosa in a 15-year-old adolescent girl. CT and an upper gastrointestinal contrast series revealed partial obstruction of the third portion of duodenum and decreased aortomesenteric distance. The patient's symptoms were successfully treated with total parental nutrition and psychiatric treatment including supportive, cognitive behavioral therapy and antidepressant medication. This case shows that SMA syndrome is an unusual gastrointestinal complication that may occur in patients with anorexia nervosa.

Acute intrathoracic gastric volvulus occurs when the stomach undergoes organoaxial torsion in the chest due to either concomitant enlargement of the hiatus or a diaphragmatic hernia. Iatrogenic diaphragmatic hernia can occur after hiatal hernia repair and other surgical procedures, such as nephrectomy, esophagogastrectomy and splenopancreatectomy. We describe a 49-year-old woman who presented to our emergency department with acute moderate epigastric soreness and vomiting. She had undergone extensive gynecologic surgery including splenectomy 1 year before. The chest radiograph obtained in the emergency department demonstrated an elevated gastric air-fluid level in the left lower lung field. An urgent gastroscopy showed twisted structural abnormality of the stomach body. A computed tomography scan demonstrated the distended stomach, located in the left lower hemithorax through a left diaphragmatic defect. Emergent transthoracic repair was performed. Postoperative recovery was uneventful, and the patient did not experience any pain or difficulty with eating.

Trichloroethylene is commonly used as an industrial solvent and degreasing agent. The clinical features of acute and chronic intoxication with trichloroethylene are well-known and have been described in many reports, but hypersensitivity syndrome caused by trichloroethylene is rarely encountered. For managing patients with trichloroethylene hypersensitivity syndrome, avoiding trichloroethylene and initiating glucocorticoid have been generally accepted. Generally, glucocorticoid had been tapered as trichloroethylene hypersensitivity syndrome had ameliorated. However, we encountered a typical case of trichloroethylene hypersensitivity syndrome refractory to high dose glucocorticoid treatment. A 54-year-old Korean man developed jaundice, fever, red sore eyes, and generalized erythematous maculopapular rashes. A detailed history revealed occupational exposure to trichloroethylene. After starting intravenous methylprednisolone, his clinical condition improved remarkably, but we could not reduce prednisolone because his liver enzyme and total bilirubin began to rise within 2 days after reducing prednisolone under 60 mg/day. We recommended an extended admission for complete recovery, but the patient decided to leave the hospital against medical advice. The patient visited the emergency department due to pneumonia and developed asystole, which did not respond to resuscitation.

Bleeding from ectopic varices is rare and accounts for only 1% and 5% of all variceal bleeding. However, once the bleeding starts, it becomes difficult to control and is sometimes fatal. We faced a 65-year-old man with ruptured duodenal varices and injected N-butyl-2-cyanoacrylate into the spurting duodenal varices. As a result, oozing was successfully controlled. Subsequently, the patient remained hemodynamically stable, and no repeat -butyl-2-cyanoacrylate injection was needed. He was finally discharged one week later and has been followed-up for the last one year with no signs and symptoms to suggest any recurrence of bleeding.