Anorexia nervosa and necrotizing colitis: case report and review of the literature

Abstract

Summary:A 20 year old woman with anorexia nervosa and severe weight loss developed extensive necrotizing colitis after being admitted to hospital for stabilization of her weight. Necrotizing colitis with anorexia nervosa has been reported previously. We report a second case. We believe necrotizing colitis is a true complication of anorexia nervosa and should be considered in the differential diagnosis in patients with primary anorexia who develop an acute abdomen.

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

“…Although Clostridium was not noted in our case reports, other aspects of these case reports were similar including gastric dilatation and stasis, and faecal impaction; as well as the presence of binge eating/re-feeding. Sakka et al described a similarity between this condition and enteritis necroticans observed in prisoners of war following re-feeding of comparatively small amounts [10]; with haemorrhagic, inflammatory or ischaemic necrosis of the jejunum being characteristic [13].…”

“…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). …”

“…Diamanti et al suggested a similarity to necrotizing colitis in the new-born with starvation leading to reduced mucosal integrity, intestinal ischaemia and impairment of digestive motility [7]. The presence of gas producing bacteria was evident in three of the case reports [7], [8], [10]. The association of clostridium and anorexia nervosa has not been fully elucidated or established.…”

Funktionelle Duodenalstenose bei Anorexia nervosa

“…Im Rahmen des zunehmenden Hungerzustands kann es neben den kardialen, renalen, endokrinologischen, hämatologischen und/oder dermatologischen Komplikationen [3,5,14,17] auch zu gastroenterologischen Störungen [4,11,16] kommen. Im Rahmen des zunehmenden Hungerzustands kann es neben den kardialen, renalen, endokrinologischen, hämatologischen und/oder dermatologischen Komplikationen [3,5,14,17] auch zu gastroenterologischen Störungen [4,11,16] kommen.…”