Anesth Pain Med.  2020 Apr;15(2):251-258. 10.17085/apm.2020.15.2.251.

Abdominal compartment syndrome caused by gastric distension in bulimia nervosa and fatal injury following surgical decompression - A case report -

• Eom Bh
• Lim HK
• Tae N
• Shinn HK

• KMID: 2500980
• DOI: http://doi.org/10.17085/apm.2020.15.2.251

Abstract

Background
Abdominal compartment syndrome (ACS) occurs due to increased abdominal cavity pressure, causes multiple organ damage, and leads to fatal consequences. Increased intraperitoneal pressure due to different reasons generally does not result in serious damage, due to the compliance of the abdominal wall. However, when the pressure exceeds the limit, ACS develops, thereby causing fatal damage to the organs. Case: A patient presented with rapid stomach swelling due to excessive food intake and was known to have bulimia nervosa, which had now resulted in ACS. Mental changes, abdominal distension, color change in the legs, acute kidney injury, and acidosis were seen. The patient expired due to ischemia-reperfusion injury and disseminated intravascular coagulation, which occurred after surgical decompression.
Conclusions
Under suspected ACS conditions, we should be aware of various symptoms that can occur. Early attempts for decompression are helpful, and it is important to be prepared for reperfusion injury prior to surgical decompression attempts.

Keyword

Bulimia; Intra-abdominal hypertension; Reperfusion injury; Shock, hemorrhagic

Figure

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  Fig. 1. The plain abdominal X-ray image shows markedly dilated state in stomach with abundant food materials.

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  Fig. 2. The abdomen-pelvis computed tomography axial (A) and coronal (B) images revealing markedly distended stomach, dilated distal esophagus and proximal duodenum.

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  Fig. 3. Axial (A) and coronal (B) images of the abdomen–pelvis computed tomography (CT). CT shows coiling of L-tube tip in distal esophagus.

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