Acute Gastric Dilatation and Acute Pancreatitis in a Patient with an Eating Disorder: Solving a Chicken and Egg Situation

Abstract

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.

Duodenal Loop Obstruction as an Unusual Cause of Acute Pancreatitis: A Case Series

“…5 The current cases revealed a resemblance to the normal plain abdomen due to the little amount of gas that was contained in the fluid-filled stomach and duodenal loop. Abdominal CT scan is an essential diagnostic tool for acute pancreatitis caused by duodenal loop obstruction.…”

“…5 In most cases, acute pancreatitis related to duodenal loop obstruction developed after surgery, such as ALO as a consequence of Billroth II reconstructions after gastrectomy and small intestinal adhesions after Roux-en-Y gastrectomy, gastric bypass surgery, biliary diversions, internal hernias, 1 and fundoplication for gastroesophageal reflux disorder. 12 However, in some cases, acute pancreatitis developed without prior surgery and presented as a markedly distended stomach after binge eating 5 or with ventral hernias. 2 Closed duodenal loop triggering acute pancreatitis, called the "Pfeffer model," was introduced in 1957.…”

“…5 Afferent loop obstruction (ALO), which is the most common cause of duodenal loop obstruction, develops after gastrectomy with Billroth II anastomosis. 1 However, it is possible for a functional blind duodenal loop to appear after Roux-en-Y gastrectomy, gastric bypass surgery, biliary diversion, and internal hernia.…”

“…1 In addition, a markedly distended stomach triggers acute pancreatitis with duodenal compression. 5 Increased intraluminal pressure of the duodenum and pancreatic duct inhibits pancreatic juice drainage and induces acute pancreatitis. 1 Ileus and acute pancreatitis are closely related; both are causes and results, and vice versa.…”

An Exceptional Case of Acute Respiratory Failure Caused by Intra‐Thoracic Gastric Perforation Secondary to Overeating

“…The scarcity of reported cases represents somewhat of a novelty for the forensic pathologist who approaches the case. Death occurred in only four cases and was generally due to acute gastric perforation into the abdominal cavity (2)(3)(4)(5). In this study, the authors provide an in-depth analysis of a fatal case that occurred in Rome during 2016 to provide more information on this type of event.…”