HISTORY AND CLINICAL FINDINGS: Abdominal pain developed after a bulimic binge in a 19-year-old girl with anorexia nervosa. She had unsuccessfully tried to induce vomiting. Physical examination showed no clinical sign of peritonitis, although there was diffuse abdominal tenderness on pressure.

INVESTIGATIONS: There was leukopenia (2200 G/l) and a raised serum lactate level (58 mg/dl). No free air was seen on a plain film of the abdomen. Abdominal sonography revealed little free fluid subhepatically.

TREATMENT AND COURSE: Acute respiratory impairment during investigations required emergency intubation. As bronchoscopy revealed aspiration a bronchial lavage was performed. Under gastroscopic control gastric emptying was achieved through a large gastric tube.

After early improvement the patient developed the full picture of sepsis. Ultrasonography and needle puncture having revealed purulent intraabdominal fluid, a laparotomy was performed, which showed necrosis of the anterior and posterior walls of the stomach with free perforation. The greater curvature was resected. The patient slowly recovered but a relaparotomy for a subphrenic abscess became necessary on the 10th postoperative day. A year later there was free food passage, but the anorexia nervosa was unchanged.

CONCLUSION: A bulimic binge can become life-threatening if the stomach does not empty spontaneously. Surgical intervention is required, if the patient's condition does not improve despite gastric emptying.

About the Authors

Willeke F, Riedl S, von Herbay A, Schmidt H, Hoffmann V, Stern J. (1996) Decompensated acute gastric dilatation caused by a bulimic attack in anorexia nervosa. Dtsch Med Wochenschr. 1996 Oct 4;121(40):1220-5. Chirurgische Klinik, Universitat Heidelberg.