Abdominal Aortic Blood Flow Disturbance Due to Binge Eating

  • Tsunehiko Maruyama
  • Yuichiro Yoshioka
  • Shuji Suzuki
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Keywords

Anorexia nervosa Binge eating 
A 38-year-old man visited our emergency department with symptoms of abdominal distention (Fig. 1). He suffered from anorexia nervosa, repeatedly refusing food and overeating. He said that he had more than 10 meals at lunch. His abdominal distention was prominent and cyanosis of the lower limb was observed (Fig. 2). An abdominal contrast-enhanced computed tomography scan indicated that the descending aorta was pressed by the expanded stomach, and blockage of blood flow was observed (Fig. 3). Free gas was also found in the peritoneal cavity. Therefore, we performed an urgent laparotomy and punctured the stomach to reduce the pressure; however, pulseless ventricular fibrillation occurred during surgery. He died after resuscitation was not successful in restoring his normal heart rate. His blood potassium was 10.3 mEq/l.
Fig. 1

Patient with a prominent abdominal distension

Fig. 2

Cyanosis of the lower limb was observed of the patient

Fig. 3

Computed tomography showing absence of contrast in the abdominal aorta due to compression and occlusion by the massively distended stomach (arrow)

Aortic compression and occlusion secondary to acute gastric dilatation was initially reported in 2006 involving a 22-year-old female anorexic patient who developed acute gastric dilatation following a binge episode. In this case, there was a rapid return of the circulation after decompression of the stomach, the bowel appeared viable and the abdomen was closed. Unfortunately, the patient died 36 h after developing severe metabolic acidosis and disseminated intravascular coagulation secondary to reperfusion injury.1 In a similar case, there is report of survival by performing several intestinal resections after the initial gastric decompression surgery.2

We believe that it would have been difficult to save him. However, artificial dialysis or percutaneous cardiopulmonary support should have been instated.

Notes

Author Contribution

All persons who meet authorship criteria are listed as authors, and all authors certify that they have participated sufficiently in the work to take public responsibility for the content, including participation in the concept, design, analysis, writing, or revision of the manuscript. Furthermore, each author certifies that this material or similar material has not been and will not be submitted to or published in any other publication before its appearance in the Journal of Gastrointestinal Surgery.

Conception and design of study: T Maruyama, Y Yoshioka

Acquisition of data: T Maruyama, Y Yoshioka

Analysis and/or interpretation of data: T Maruyama, Y Yoshioka, S Suzuki

Drafting the manuscript: T Maruyama

Revising the manuscript critically for important intellectual content: Y Yoshioka, S Suzuki

Approval of the version of the manuscript to be published: T Maruyama, Y Yoshioka, S Suzuki

References

  1. 1.
    Gyurkovics E, Tihanyi B, Szijarto A, et al. Fatal outcome from extreme acute gastric dilation after an eating binge. Int J Eat Disord. 2006;39:602–605.CrossRefPubMedGoogle Scholar
  2. 2.
    Elsharif M, Doulias T, Aljundi W, Balchandra S. Abdominal aortic occlusion and vascular compromise secondary to acute gastric dilatation in a patient with bulimia. Ann R Coll Surg Engl. 2014;96:e15–17.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2018

Authors and Affiliations

  1. 1.Department of Gastroenterological Surgery, Ibaraki Medical CenterTokyo Medical UniversityIbarakiJapan
  2. 2.Department of SurgeryJyoban HospitalIwakiJapan

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