Extreme acute gastric dilatation after a bulimic attack

This is a case report of a 22-year-old woman, with acute gastric dilatation, caused by bulimia, complicated with severe and irreversible shock.

History and clinical findings: The patient was referred with acute abdominal pain and abdominal distension to our department. After a bulimic attack, her complains (diarrhoea, vomiting, later inability to vomit, severe abdominal pain, and bowel distension) started about 5–6 hours before admission. Physical examination showed an extremely distended abdomen. The lower extremities were cold and cyanotic, and the femoral pulse was absent.

Investigations: The plan film, the CT scan and the UH of the abdomen showed massive dilatation of the stomach with a huge fluid level in it and in the duodenum, and the compression of the abdominal part of the aorta and the mesenteric veins.

Treatment: Urgent laparotomy was performed. At about 11–12 liters of vegetable-fluid gastric content were removed through a gastrotomy. Following this gastric decompression, the mesenteric pulse reappeared. Unfortunately the reperfusion of the retroperitoneal organs and the lower extremities she had got severe acidosis, with hypernatremy. During the operation her cardio-respiratory system were stabilized, but she went into a severe and irreversible shock in the next 24 hours, and she died in 36 hours.

Conclusion: A bulimic binge can become life threatening. Our case demonstrates a rare complication in some respects. She had an extreme gastric dilatation with compression of the retroperitoneal organs and vessels, which caused an ischemic injury of these organs and the lower extremities. Clinicians should be aware that abnormal eating habits can cause severe somatic complications even in patients of normal weight, who are not diagnosed as having an eating disorder.