Bowel ischemia and necrosis in anorexia nervosa: A case report and review of the literature

Abstract

HighlightsBowel ischemia and necrosis is an uncommon complication of anorexia nervosa.We present a case of a 30 year old woman with long-standing AN complicated by ischemia and necrosis of the entire small bowel and the right hemicolon.A high index of suspicion of bowel ischemia is necessary when patients with AN present with abdominal symptoms.Timely diagnosis and treatment may prevent bowel necrosis and death.

Case Report of the surgical management of small bowel and colonic ischaemia associated with Anorexia Nervosa binge/purge subtype

“…Significant binge eating episodes in this patient group have previously been reported to be associated with surgical emergencies such as acute gastric dilation which can lead to complications such as gastric necrosis and perforation [1], [3], [4], [5]. There are only five previously reported cases of binge eating episodes resulting in small bowel and colonic ischaemia, the majority resulting in mortality [6], [7], [8], [9], [10]. Here, we report our own experience and successful surgical management of an Anorexia Nerovsa patient exhibiting binge/purge subtype with small bowel and colon ischaemia and review the existing cases in the literature.…”

“…Small bowel and colonic ischaemia following an episode of binge eating are exceptionally rare and are associated with a mortality rate of 80% according to previously reported cases [6], [7], [8], [9], [10] (Table 1). …”

Gastrointestinal complications associated with anorexia nervosa: A systematic review

“…154 Because of such risks cisparide can no longer be prescribed in Canada or the United States and health advisories have been issued by Health Canada regarding domperidone. 154,173 Prescribers must balance the need for medication for symptoms such as bloating, fullness and satiety with a careful risk-benefit analysis. Depending on case specifics, confirmation and demonstration of gastroparesis by nucleur gastric emptying scan may be considered prior to the administration of a pro-kinetic agent.…”

“…Pro‐kinetics were the only class of medications investigated in any trial, and medications such as cisapride and domperidone have documented cardiac side effects that synergistically with severe malnutrition may endanger the ED patient through prolongation of the QTc . Because of such risks cisparide can no longer be prescribed in Canada or the United States and health advisories have been issued by Health Canada regarding domperidone . Prescribers must balance the need for medication for symptoms such as bloating, fullness and satiety with a careful risk‐benefit analysis.…”

Necrotising enterocolitis in an adult with anorexia nervosa

“…8,10 Further investigations prove characteristic appearances of the bowel. Abdominal x-ray and computed tomography often show dilated or 'fixed' bowel loops, 11 pneumatosis intestinalis or intramural gas revealed by bowel wall thickening, [12][13][14] hepatoportal venous gas forced into circulation by increased intra-abdominal pressure and free peritoneal gas resulting from bowel wall perforation. 9,11,14 This gas is thought to arise from mechanisms involving overgrowth and invasion of pathogenic bacteria.…”