Acute gastric dilatation in a patient with severe anorexia nervosa: a case report

Abstract

Background Acute gastric dilatation (AGD) leading to gastric necrosis and perforation has been reported to be a rare but fatal complication in young patients with eating disorders, particularly anorexia nervosa. Case presentation We report a case of a Canadian female patient presenting with mild abdominal pain, with a history of anorexia nervosa, the binge/purge subtype, who was found to have severe acute gastric dilatation on subsequent computed tomography imaging. Her clinical course was uncomplicated after gastric decompression. The cause of her AGD was thought to be secondary to dysmotility disorder caused by her anorexia nervosa. Conclusion Our case report demonstrates the importance of clinical identification of AGD and subsequent diagnosis and management. Because of the urgency to rule out obstruction or perforation through consultation or additional imaging modalities, recognition and correct diagnosis of this condition is necessary for appropriate patient management. In addition, our case report adds to an underreported but important complication of anorexia nervosa.

Gastric dilatation in patients with restrictive eating disorders

“…However, the association between increased gastric dimensions and gastrointestinal (GI) symptoms, as well as risk for gastric necrosis and perforation, remain to be determined. Pitre et al (2021) reported a gastric dimension of 17 × 18 × 24 cm (~4 L) on CT scan of a patient with severe AN without evidence of necrosis on upper endoscopy. Tweed‐Kent et al (2010) described a stomach measuring 32 × 17.9 cm on CT scan in a patient with AN‐BP, and with evidence of gastric necrosis on laparotomy along with nearly 2 gallons of intragastric material.…”

“…Among individuals with eating disorders (EDs), this condition has only been described on the basis of presumed acute etiology (i.e., acute gastric dilatation), clinically presenting with acute onset epigastric or left upper quadrant abdominal pain along with nausea, vomiting, and frequently abdominal distension. Proposed etiologies for the development of acute gastric dilatation, in those with restrictive EDs, have included: mechanical obstruction due to superior mesenteric artery (SMA) syndrome (Mascolo et al, 2015); following consumption of a large binge (Gyurkovics et al, 2006); in the setting of electrolyte disturbances (Panyko et al, 2020); secondary to gastroparesis, or slowed gastric emptying (Pitre et al, 2021); and secondary to gastric atonicity with distension developing upon resumption of food intake (Vettoretto et al, 2010). However, baseline gastric dimensions in malnourished individuals, secondary to restrictive EDs, have never been examined.…”

“…Pitre et al (2021) reported a gastric dimension of 17 Â 18 Â 24 cm ($4 L) on CT scan of a patient with severe AN without evidence of necrosis on upper endoscopy.Tweed-Kent et al (2010) described a stomach measuring 32 Â 17.9 cm on CT scan in a patient with AN-BP, and with evidence of gastric necrosis on laparotomy along with nearly 2 gallons of intragastric material Vettoretto et al (2010). reported that intraluminal gastric contents consisting of even 3 L can distend the stomach to an intraluminal pressure that impedes blood flow and increases risk for gastric necrosis and perforation.…”

Endoscopic management of giant gastric dilatation in an anorexia nervosa patient after binge eating

“…Previously published cases suggest that massive gastric dilatation may require first-line surgical intervention to address or prevent complications such as perforation, peritonitis, shock, and death [4,5]. In contrast, other case reports with uncomplicated acute gastric dilatation showed that placement of a nasogastric tube alone for decompression could also be an effective treatment [7,8,9]. However, one case report was published about a fatal course of acute gastric dilatation that went unnoticed but was subsequently confirmed by autopsy [6].…”

Renutrition and management of severe anorexia nervosa in intensive care: Review and multidisciplinary approach

“…Symptoms are unremarkable and include nausea, vomiting, pain and abdominal distension. CT scan can reveal a dilated stomach and eliminate a complication [66]. Prompt nasogastric aspiration can prevent gastric ischemia and perforation with peritonitis.…”