Fatal outcome from extreme acute gastric dilation after an eating binge

Gyurkovics, Endre; Tihanyi, Balazs; Szíjártó, Attila; Kaliszky, Péter; Temesi, Viktoria; Sas, Hedvig; Kempler, Péter

doi:10.1002/eat.20281

Cited by 52 publications

(35 citation statements)

References 6 publications

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“…If the syndromes are not diagnosed early and treated, then circulatory collapse and cardiac arrest can occur. 3,4 Initial therapy must include nasogastric decompression and fluid resuscitation. Most patients respond to nasogastric tube drainage, but some require gastrectomy with esophagojejunostomy.…”

Section: Resultsmentioning

confidence: 99%

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Acute gastric dilatation causing bacterial cerebral aneurysm—Case report

Matsuyama

Komeda

Nobayashi

et al. 2008

Intl J Eating Disorders

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Section: Resultsmentioning

confidence: 99%

“…Early recognition is essential, since 80% mortality rate has been reported with delayed treatment. 4 Even if the patients' stomach shrinks and their circulation is stabilized, they will have gastric mucosal damage. 5 There has been no report of BCA following AGD.…”

Section: Resultsmentioning

confidence: 99%

Acute gastric dilatation causing bacterial cerebral aneurysm—Case report

Matsuyama

Komeda

Nobayashi

et al. 2008

Intl J Eating Disorders

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“…6 In that case, there was also rapid return of circulation following gastric decompression, the bowel appeared viable and the abdomen was closed. Unfortunately, the patient died 36 hours later, having developed severe metabolic acidosis and disseminated intravascular coagulation secondary to reperfusion injury.…”

Section: Online Case Reportmentioning

confidence: 90%

Abdominal aortic occlusion and vascular compromise secondary to acute gastric dilatation in a patient with bulimia

Elsharif

Doulias

Al-Jundi

et al. 2014

annals

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Acute gastric dilation is a rare but recognised complication in patients with bulimia and anorexia following binge episodes owing to decreased bowel motility. We present a rare case of acute gastric dilation secondary to bulimia in an otherwise healthy 18-year-old female patient that resulted in compression and complete occlusion of the abdominal aorta, leading to acute mesenteric and bilateral lower limb ischaemia. This resolved immediately following a laparotomy and gastric decompression.Management of these patients is very challenging owing to the lack of a successful precedent. To our knowledge, such a catastrophic complication has only ever been reported once in the literature and the outcome was fatal. Our case is of additional importance as it offers a successful management strategy for these patients. KEYWORDSAcute gastric dilation -Aortic occlusion -Bulimia Case HistoryAn 18-year-old woman with bulimia presented to the emergency department with sudden onset of severe abdominal pain and distension over the previous 2 hours. Within 30 minutes of arrival, her pain started to radiate to her back, she became unresponsive and developed extensive mottling of the skin from the waist down. Further examination revealed a grossly distended abdomen, engorged neck veins and absent femoral pulses bilaterally. She had a blood pressure of 190/132mmHg, a pulse rate of 100/min, a respiratory rate of 28/min, oxygen saturation of 98% on air and a temperature of 37.2°C.Assuming a diagnosis of aortic dissection, the on-call vascular surgeon was bleeped to the emergency department while the patient was being intubated and resuscitated. A venous blood gas sample showed she was in profound metabolic acidosis with a pH of 7.1 and a lactate of 7.6.As the patient was haemodynamically stable, urgent computed tomography was performed. This revealed a massively dilated stomach occupying the majority of the abdominal cavity from the epigastrium down into the pelvis with gas extending into the liver and spleen (Fig 1). Alarmingly, it also showed that the abdominal aorta was being compressed and completely occluded above the superior mesenteric artery origin (Figs 2 and 3).The patient was taken to theatre for an emergency laparotomy and on opening the abdominal cavity, she was also found to have extensive small and large bowel ischaemia. A gastrotomy was performed and the stomach was decompressed, with a total of 15l of gastric content being emptied. This resulted in an immediate restoration of circulation with reperfusion of the bowel and return of femoral pulses bilaterally. She was transferred to the intensive care unit (ICU) with a laparostomy and a plan for a 'relook' laparotomy in 48 hours.Unfortunately, over the next 24 hours, the patient developed disseminated intravascular coagulopathy and liver failure, and went into a profound metabolic acidosis. She was returned to theatre and an extended right hemicolectomy with an end ileostomy was performed for necrosis of the ascending and transverse colon. The stomach was also ...

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“…Other cases of gastric dilatation (both with or without perforation of the stomach) have been reported as a result of air swallowing or after Nissen fundoplication [1,2] and also after excessive eating, pylorospasm with threat of peptic ulcer disease [2,3], acute pancreatitis, gastric haemorrhage, injury, pregnancy or ingestion of sodium bicarbonate. Additionally there are cases documenting complications involving gastric infarction with perforation, compression of the aorta with ischemic injury of the bowels and lower arteries [4]. A near complete necrosis and perforation is extremely uncommon, because the rich blood supply of the stomach would normally protect from ischemia in gastric dilatation.…”

Section: Discussionmentioning

confidence: 99%

Life-threatening gastric dilatation with anorexia nervosa

et al. 2011

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Background: Gastric dilatation can turn into a life-threatening condition including bleeding, necrotic intestinal wall, intra-abdominal rupture and severe lung complications with aspiration and respiratory insufficiency.Methods: Case report.Results: We present a case of a young female patient with anorexia nervosa and massive chronic gastric dilatation, necrotic gastric wall and chronic aspiration with respiratory insufficiency that was successfully treated mainly conservative with prokinetic agents and PPI (proton pump inhibitor). Surgery was necessary for the treatment of the appearing complications.Conclusions: As shown in our case conservative management of gastric dilatation is a good alternative to primarily operative treatment.

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Fatal outcome from extreme acute gastric dilation after an eating binge

Cited by 52 publications

References 6 publications

Acute gastric dilatation causing bacterial cerebral aneurysm—Case report

Acute gastric dilatation causing bacterial cerebral aneurysm—Case report

Abdominal aortic occlusion and vascular compromise secondary to acute gastric dilatation in a patient with bulimia

Life-threatening gastric dilatation with anorexia nervosa

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