gastric dilatation and circulatory colla”>Case Report

Contents lists available at SciVerse ScienceDirect

American Journal of Emergency Medicine

journal homepage: locate/ ajem

Gastric dilatation and circulatory collapse due to eating disorder?

Abstract

Anorexia-bulimia is a frequent psychiatric affection in adolescent female populations [1]. Such Eating disorders may have a higher morbi-mortality than usually described in literature. Among fre- quently encountered complications of this disease, major gastric dilatation can dramatically evolve to death. We present the case of a young woman which presented a rare cause of acute Abdominal compartment syndrome.

An 18-year-old female was admitted in our intensive care unit for acute cardiac output impairment. She had a past-medical history of anorexia bulimia. After a recent loss of 7 kg, her body mass index was

11.4 kg/m [2]. She presented to the emergency department (ED) for acute abdominal pain occurring a few hours after a bulimia crisis. She had a surgical clinical presentation. Her cardiac rate was 130 bpm and her mean arterial blood pressure was 55 mmHg. The diagnosis of intra- abdominal complication was suspected. Biological exams revealed an acute renal failure with an increase of nearly 50% of creatininemia and an increased lactate level (3.2 mmol.l^-1). Cardiac echography showed low filling pressure with a supra normal left ventricular function. Computed tomography showed a massive gastric overdistension (Fig. A and B) with inferior vena cava compression (Fig. B, arrow). Consecutively, Small intestine and colon were in a pelvic position (Fig. A). After removal of over 5 L of fluid by nasogastric aspiration and Fluid loading, pain was relieved, blood lactate level decreased to 1.3 mmol.l^-1and renal function normalized. This intra-abdominal hyper- pressure syndrome due to an acute gastric overdistension was completely corrected after 24 hours of gastric-aspiration.

Gastric dilatation is a rare but serious complication already reported in patients with eating disorder. Episodes of acute gastric dilatation may be complicated by gastric necrosis [2], gastric perfo- ration [3], and death [4]. Hypotension following a gastric dilatation has been described and explained by a direct compression of the inferior vena cava [5]. Hypotension has been reported to be reversible after gastric decompression [6] comforting the mechanism of extrinsic compression of intra-abdominal vessels.

Despite the high prevalence of eating disorders [7], literature poorly describes such major complications. This rare but life-threatening complication of massive food intake should to be known by physicians who take care of patients suffering from Anorexia nervosa-bulimia whose gastrointestinal motility is frequently disturbed [8].

This case report describes a typical presentation of acute abdominal hypertension syndrome due to a major gastric dilatation following a massive food intake. Despite a high prevalence of the

? All authors have substantially contributed to the conception, the design, and the acquisition of data of the article. They both drafted the article and revised it critically for important intellectual content. They gave their approval of the version to be published. E-mail address: [email protected] (X. Repesse).

disease, this complication of anorexia - bulimia is rarely reported in literature. This presentation should be seriously considered by physicians in order to rapidly initiate the treatment which simply consists in gastric emptying by nasogastric tube.

Xavier Repesse MD Laurent Bodson MD Siu-Ming Au MD

Assistance Publique-Hopitaux de Paris University Hospital Ambroise Pare, Intensive Care Unit Section Thorax-Vascular Disease-Abdomen-Metabolism

Boulogne-Billancourt, 92100, France Faculty of Medicine Paris Ile-de-France Ouest University of Versailles Saint-Quentin en Yvelines Saint-Quentin en Yvelines, 78280, France

E-mail address: [email protected]

Cyril Charron MD

Assistance Publique-Hopitaux de Paris University Hospital Ambroise Pare, Intensive Care Unit Section Thorax-Vascular Disease-Abdomen-Metabolism

Boulogne-Billancourt, 92100, France

Antoine Vieillard-Baron MD, PhD

Assistance Publique-Hopitaux de Paris University Hospital Ambroise Pare, Intensive Care Unit Section Thorax-Vascular Disease-Abdomen-Metabolism

Boulogne-Billancourt, 92100, France Faculty of Medicine Paris Ile-de-France Ouest University of Versailles Saint-Quentin en Yvelines Saint-Quentin en Yvelines, 78280, France

http://dx.doi.org/10.1016/j.ajem.2012.10.018

References

1. Smink FR, van Hoeken D, Hoek HW. Epidemiology of eating disorders: incidence, prevalence and mortality rates. Curr Psychiatry Rep 2012;14:406-14.
2. Reeve T, Jackson B, Scott-Conner C, Sledge C. Near-total gastric necrosis caused by acute gastric dilatation. South Med J 1988;81:515-7.
3. Beiles CB, Rogers G, Upjohn J, Wise AG. Gastric dilatation and necrosis in bulimia: a case report. Australas Radiol 1992;36:75-6.
4. Edwards GM. Case of Bulimia nervosa presenting with acute, fatal abdominal distension. Lancet 1985;1:822-3.
5. Englar HS, Kennedy TE, Ellison LT. Hemodynamics of experimental acute gastric dilatation. Am J Surg 1967;113:194-8.
6. Cogbill TH, Bintz M, Johnson JA, Strutt PJ. Acute gastric dilatation after trauma. J Trauma 1987;27:1113-7.
7. Hudson JI, Hiripi E, Pope Jr HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 2007;61: 348-58.
8. Hadley SJ, Walsh BT. Gastrointestinal disturbances in anorexia nervosa and bulimia nervosa. Curr Drug Targets CNS Neurol Disord 2003;2:1-9.

   0735-6757/$ - see front matter (C) 2013

   

   Fig. Injected Abdominal computed tomography (CT) scan: frontal view (A) and axial view (B).