Clinical Communications: Adults
Acute Gastric Dilatation Causing Acute Limb Ischemia in an Anorexia Nervosa Patient

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Abstract

Background

Acute gastric dilatation is a rare but severe complication of anorexia nervosa. Gastric dilatation causing abdominal compartment syndrome with lower-limb ischemia is even less common. This case report illustrates the importance of a holistic clinical approach of every patient presenting to the emergency department (ED), even when the reason for admittance is organ specific.

Case Report

We report the case of a young female patient presenting to the ED with a painful white left leg. Clinical examination revealed acute lower-limb ischemia, abdominal distention, and shock. Diagnostic work-up, including an abdominal computed tomography scan, showed compression of the aorta, inferior vena cava, and both iliac arteries, as well as hypoperfusion of the right kidney and left liver lobe, all due to compression by a massive gastric dilatation. Gastroscopy revealed a massively dilated stomach containing > 6 L of fluid and gastric wall ischemia. After decompression, the circulation to the lower limbs recovered immediately. The day after admission the patient developed an acute abdomen leading to a semi-urgent laparoscopy during which a sleeve gastrectomy was performed for the treatment of partial gastric necrosis. Clinical evolution afterward was favorable and the patient recovered completely.

Conclusions

This case report underscores the importance of a thorough clinical examination in every patient admitted to the ED. Early diagnosis and treatment are mandatory in preventing fatal complications.

Introduction

Acute gastric dilatation (AGD) is a rare but potentially life-threatening complication of anorexia nervosa and bulimia nervosa (1). It is considered a surgical emergency because AGD can lead to an abdominal compartment syndrome (ACS) and therefore to shock and death if treatment is delayed 2, 3, 4, 5, 6. Only a few references are found when reviewing the literature, and most of them are case reports. We present a case of extreme gastric dilatation causing ACS with acute lower-limb ischemia. Due to early diagnosis and treatment, the patient recovered completely.

Section snippets

Case Report

A 19-year-old female patient was admitted to the emergency department (ED) complaining of a painful white left leg with diminished strength and sensibility. She also complained of severe pain in the lower back and gluteal area. The pain had a sudden onset and she had no previous complaints in her legs.

Medical anamnesis consisted of anorexia nervosa. The patient admitted to compulsively drinking milk and water the day before. She had failed to induce vomiting. On physical examination, vital

Discussion

Acute gastric dilatation is a rare but severe condition. It is seen as a complication of anorexia nervosa, but can also result from a variety of disorders, such as gastric volvulus, abdominal surgery, diabetes mellitus, gastrointestinal tumors, or the superior mesenteric artery syndrome 5, 6, 7, 8. The pathophysiology of acute gastric dilatation in anorectic patients is associated with prolonged emptying of the stomach. This is due to weaker peristaltic movements of stomach and duodenum and

Conclusions

This case report underscores the importance of a thorough clinical examination in every patient admitted to the ED. Emergency physicians should be aware of the possible somatic complications of psychiatric disorders, such as anorexia nervosa. Early diagnosis and treatment are mandatory in preventing fatal complications.

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