Endoscopic management of giant gastric dilatation in an anorexia nervosa patient after binge eating

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 - Endoskopie

Keywords

Overtube - Gastroscopy - Anorexia Nervosa - Bulimia - Gastric Dilatation - Binge Eating - Endoscopy

Publication History

Received: 18 April 2021

Accepted after revision: 14 September 2021

Article published online:
24 November 2021

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