J Korean Surg Soc.  2011 Dec;81(Suppl 1):S1-S5. 10.4174/jkss.2011.81.Suppl1.S1.

Abdominal compartment syndrome caused by a bulimic attack in a bulimia nervosa patient

• Kim BS
• Kwon JW
• Kim MJ
• Ahn SE
• Park HC
• Lee BH

• KMID: 1445775
• DOI: http://doi.org/10.4174/jkss.2011.81.Suppl1.S1

Abstract

We present a rare case of abdominal compartment syndrome due to a bulimic attack in a 19-year-old female patient with bulimia nervosa. She was admitted to our emergency room with complaints of progressive abdominal pain following bulimia. Computed tomography showed dilated stomach with food and air pressed other visceral organs and major abdominal vessels. Decompression using nasogastric tube or gastric lavage tube failed. At laparotomy, we performed gastrotomy and decompression was performed. After decompression, she fell into hypovolemic shock due to bleeding in the intra-gastric and peritoneal cavity. Twelve hours after the operation, the patient died due to refractory hypovolemic shock from uncontrolled bleeding following decompression of abdominal compartment. It should keep in mind that binge-eating habits in patients with bulimic nervosa could cause abdominal compartment syndrome due to gastric distension and this may be a potentially fatal condition.

Keyword

Compartment syndromes; Bulimia; Reperfusion injury

MeSH Terms

Abdominal Pain
Bulimia
Bulimia Nervosa
Compartment Syndromes
Decompression
Emergencies
Female
Gastric Lavage
Hemorrhage
Humans
Intra-Abdominal Hypertension
Laparotomy
Peritoneal Cavity
Reperfusion Injury
Shock
Stomach
Young Adult

Figure

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  Fig. 1 Plain abdominal X-ray revealed severely distended stomach with large amount of food materials.

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  Fig. 2 Computed tomography showed abdominal compartment syndrome due to gastric distension. Enhancement of right kidney was good, but left kidney was not enhanced. Abdominal aorta was compressed.

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  Fig. 3 Both feet showed cyanotic change.

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  Fig. 4 Gastrotomy was performed. Gastric wall demonstrated red spots after decompression.

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