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DOI: 10.1055/a-1649-8131
Endoscopic management of giant gastric dilatation in an anorexia nervosa patient after binge eating
Endoskopische Therapie einer riesigen Magendilatation bei einer Patientin mit Anorexia nervosa nach „Fressattacke“![](https://www.thieme-connect.de/media/zfg/202207/lookinside/thumbnails/zfg-0067_10-1055-a-1649-8131-1.jpg)
Abstract
Acute gastric dilatation is a rare and potentially life-threatening condition that may occur in patients suffering from anorexia nervosa after ingesting large amounts of food within a short period. Frequently, this condition is considered a surgical emergency due to subsequent occurrence of complications such as gastric necrosis or perforation.
Here we report a case of a young female patient (23 years) with anorexia nervosa who presented with severe abdominal pain, nausea, and inability to vomit after a period of binge eating. Abdominal computed tomography revealed an extremely dilated stomach measuring 39.0 cm × 18.0 cm in size. Initial nasal decompression therapy using gastric tubes had failed. Due to the absence of complications, it was decided to treat her solely by endoscopic means under mechanical ventilation. After undergoing multiple overtube-assisted esophagogastroduodenoscopies (EGDs), she fully recovered eventually.
This case demonstrates that interventional endoscopic treatment of a patient with uncomplicated acute gastric dilatation is feasible and safe, at least under general anesthesia. Hence, this option should be considered when sole gastric tube suction fails, and there is no indication of complications such as peritonitis, sepsis, perforation, or gastric ischemia. A more invasive and aggressive surgical procedure may be avoided in selected cases, and the length of hospital stay may be shortened.
Zusammenfassung
Die akute Magendilatation ist ein seltenes, potenziell lebensbedrohliches Krankheitsbild, das bei Patienten mit Anorexia nervosa nach einer Fressattacke vorkommen kann. Genaue Angaben über Häufigkeiten fehlen. Bisher wird dieses Krankheitsbild v.a. wegen Komplikationen wie drohender Nekrose oder Perforation als chirurgische Notfallsituation angesehen.
Wir berichten über den Fall einer jungen Frau (23 Jahre), die sich nach einer Bulimie-Attacke mit heftigsten abdominellen Schmerzen, Übelkeit und der Unmöglichkeit zu erbrechen notfallmäßig vorstellte. Die abdominelle Computertomografie zeigte einen massiv dilatierten Magen von 39 cm × 18 cm Größe, welcher die anderen Organe massiv verdrängte. Die Anlage einer dicklumigen Magensonde erbrachte keine relevante Besserung. Bei stabilen Kreislaufverhältnissen entschieden wir uns, nach Rücksprache mit der Viszeralchirurgie, für eine interventionelle endoskopische Therapie unter Beatmung mithilfe eines Übertubus. Nach mehreren Ösophagogastroduodenoskopien, während der Essensreste und Flüssigkeit entfernt wurden, bildete sich die Magendilatation zurück und die Patientin genas im weiteren Verlauf vollständig, sodass eine chirurgische Intervention vermieden werden konnte.
Schlüsselwörter
Übertubus - Gastroskopie - Magersucht - Bulimie - Magendilatation - Essattacke - EndoskopieKeywords
Overtube - Gastroscopy - Anorexia Nervosa - Bulimia - Gastric Dilatation - Binge Eating - EndoscopyPublikationsverlauf
Eingereicht: 18. April 2021
Angenommen nach Revision: 14. September 2021
Artikel online veröffentlicht:
24. November 2021
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References
- 1 Dingemans A, Danner U, Parks M. Emotion regulation in binge eating disorder: a review. Nutrients 2017; 9 DOI: 10.3390/nu9111274. (PMID: 29165348)
- 2 Eli K. Binge eating as a meaningful experience in bulimia nervosa and anorexia nervosa: a qualitative analysis. J Ment Health 2015; 24: 363-368 DOI: 10.3109/09638237.2015.1019049. (PMID: 25992963)
- 3 Tweed-Kent AM, Fagenholz PJ, Alam HB. Acute gastric dilatation in a patient with anorexia nervosa binge/purge subtype. J Emerg Trauma Shock 2010; 3: 403-405 DOI: 10.4103/0974-2700.70774.
- 4 Youm SM, Kim JY, Lee JR. Acute gastric dilatation causing fatal outcome in a young female with eating disorder: a case report. Korean J Anesthesiol 2015; 68: 188-192 DOI: 10.4097/kjae.2015.68.2.188.
- 5 Dewangan M, Khare MK, Mishra S. et al. Binge eating leading to acute gastric dilatation, ischemic necrosis and rupture -a case report. J Clin Diagn Res 2016; 10: PD06-PD07 DOI: 10.7860/JCDR/2016/16530.7450. (PMID: 27134932)
- 6 Watanabe S, Terazawa K, Asari M. et al. An autopsy case of sudden death due to acute gastric dilatation without rupture. Forensic Sci Int 2008; 180: e6-e10 DOI: 10.1016/j.forsciint.2008.07.005. (PMID: 18757145)
- 7 Kim HH, Park SJ, Park MI. et al. Acute gastric dilatation and acute pancreatitis in a patient with an eating disorder: solving a chicken and egg situation. Intern Med 2011; 50: 571-575 DOI: 10.2169/internalmedicine.50.4595.
- 8 Roa Esparza Í, González Ocio J, Merino Ochoa O. Acute gastric dilatation in a patient with anorexia nervosa. Rev Esp Enferm Dig 2021; 113: 302-303 DOI: 10.17235/reed.2020.7235/2020.
- 9 Pitre T, Mah J, Vertes J. et al. Acute gastric dilatation in a patient with severe anorexia nervosa: a case report. J Med Case Rep 2021; 15: 61 DOI: 10.1186/s13256-020-02575-7. (PMID: 33557865)
- 10 Panyko A, Vician M, Dubovsky M. Massive acute gastric dilatation in a patient with anorexia nervosa. J Gastrointest Surg 2021; 25: 856-858 DOI: 10.1007/s11605-020-04715-2. (PMID: 32632731)
- 11 Steen S, Lamont J, Petrey L. Acute gastric dilation and ischemia secondary to small bowel obstruction. Proc (Bayl Univ Med Cent) 2008; 21: 15-17 DOI: 10.1080/08998280.2008.11928348. (PMID: 18209748)
- 12 Nagai T, Yokoo M, Tomizawa T. et al. Acute gastric dilatation accompanied by diabetes mellitus. Intern Med 2001; 40: 320-323 DOI: 10.2169/internalmedicine.40.320. (PMID: 11334392)
- 13 Cogbill TH, Bintz M, Johnson JA. et al. Acute gastric dilatation after trauma. J Trauma 1987; 27: 1113-1117 DOI: 10.1097/00005373-198710000-00003. (PMID: 3669106)
- 14 Sato H, Tanaka T. Acute gastric dilatation due to a superior mesenteric artery syndrome: an autopsy case. BMC Gastroenterol 2014; 14: 37 DOI: 10.1186/1471-230X-14-37. (PMID: 24555911)
- 15 Hadley SJ, Walsh BT. Gastrointestinal disturbances in anorexia nervosa and bulimia nervosa. Curr Drug Targets CNS Neurol Disord 2003; 2: 1-9 DOI: 10.2174/1568007033338715. (PMID: 12769807)
- 16 Benini L, Todesco T, Dalle Grave R. et al. Gastric emptying in patients with restricting and binge/purging subtypes of anorexia nervosa. Am J Gastroenterol 2004; 99: 1448-1454 DOI: 10.1111/j.1572-0241.2004.30246.x. (PMID: 15307858)