A clinical course of a patient with anorexia nervosa receiving surgery for superior mesenteric artery syndrome

Abstract

Background Superior mesenteric artery (SMA) syndrome is a well-known but relatively rare complication of anorexia nervosa. Although several reports have proposed surgery for SMA syndrome associated with anorexia nervosa, these have shown poor outcomes or did not reveal the long-term weight course. Thus, the long-term effectiveness of surgery for SMA syndrome in such cases remains unclear. This case report describes a patient with anorexia nervosa who underwent surgery for SMA syndrome. Case presentation An 18-year-old woman presented with anorexia nervosa when she was 16 years old. She also presented with SMA syndrome, which seemed to be caused by weight loss due to the eating disorder. Nutrition therapy initially improved her body weight, but she ceased treatment. She reported that symptoms related to SMA syndrome had led to her weight loss and desired to undergo surgery. Laparoscopic duodenojejunostomy was performed, but her body weight did not improve after the surgery. The patient eventually received conservative nutritional treatment along with psychological approaches, which led to an improvement in her body weight. Conclusions The case implies that surgery for SMA syndrome in patients with anorexia nervosa is ineffective for long-term weight recovery and that conservative treatment can sufficiently improve body weight; this is consistent with the lack of evidence on the topic and reports on potential complications of surgery. Due to difficulties in assessing psychological status, consultation with specialists on eating disorders is necessary for treating patients with severely low body weight.

Predicting extremely low body weight from 12-lead electrocardiograms using a deep neural network

“…Weight measurement in patients with AN is crucial owing to the risk of severe complications such as refeeding syndrome 24 , severe liver dysfunction 25 , and thrombocytopenia 25 . However, these patients tend to deny their disease status 19 and may even falsify their weight by concealing heavy objects in their clothes during weigh-ins 20 . Furthermore, these patients may require intensive care 21 , where standard height and weight measurements may be difficult.…”

“…These suggest the plausibility of inversely predicting extremely low body weight using ECG. Such a prediction could be useful for patients with AN who deny their disease status 19 and falsify their weight, e.g., by hiding heavy objects in their clothes 20 , and for those in intensive care 21 , for whom standard weight measurements may be difficult to perform. Furthermore, if such a prediction is feasible, examining the rationale of the prediction could potentially lead to a deeper physiological understanding of ECG changes in patients with AN.…”

Superior mesenteric artery syndrome and anorexia nervosa: a case report

“…Most patients with SMA syndrome, regardless of their etiology, are initially treated conservatively with treatment goals including restoration of retroperitoneal fat to decrease symptoms caused by bowel obstruction [ 4 ]. The conservative approach includes nutritional support, fluid resuscitation, and correction of electrolyte abnormalities [ 11 ]. If the patient fails to respond to conservative therapy, surgery is indicated, including gastrojejunostomy and duodenojejunostomy, which have high success rates [ 11 ].…”

Wilkie’s syndrome as a cause of anxiety-depressive disorder: A case report and review of literature

“…Although there are several reports of SMA syndrome, diagnosed as a complication of anorexia nervosa, only a few of them emphasize the evolution of psychiatric disease. Kurisu et al [ 38 ] pointed out that surgical treatment must be cautiously considered in cases of anorexia nervosa, as the long-term results are unclear. They also reported the case of a patient with anorexia nervosa and SMA syndrome treated with surgery, without postoperative improvement.…”

“…They also reported the case of a patient with anorexia nervosa and SMA syndrome treated with surgery, without postoperative improvement. In this case, a psychological approach was necessary to be continued[ 38 ]. On the other hand, Kornmehl et al [ 39 ] emphasized the overdiagnosis of anorexia nervosa, while SMA syndrome should be considered in these cases.…”