A 31-year-old woman with a history of multiple sclerosis and ongoing treatment with interferon and nerve, diagnosed two years ago, presented to the emergency department with acute abdominal pain following a binge.
He was under individual and group psychotherapeutic treatment.
Denies previous suicide attempts or psychiatric admissions.
Food binge eating began at 15 years of age in relation to the stress caused by the tests and since then, his life revolves around them and purging behaviors.
Make sure binge eating interferes with the development of a normal working and social life.
Since the onset of eating disorders, the number of binge eating episodes exceeds the monthly frequency.
Purging measures commonly used are provoked vomiting and laxatives.
The patient came to the emergency room for severe abdominal pain lasting 7 hours, accompanied by a feeling of fullness, nausea and vomiting.
She says she has eaten a lot of food in the past few hours, after which she has vomited several times without being effective.
On physical examination, the patient's thinness is highlighted: height 159 cm, weight 42 kg (BMI: 17), globulous abdomen is noteworthy, tympanic, with few intestinal sounds.
Temperature 36.3 oC, blood pressure 125 mmHg and heart rate 75 bpm.
A simple abdominal X-ray showed a large gastric dilatation.
Lymphocyte count :19,800 with 93.5% of eosinophil counts.
Amylase 286 IU/ l, blood glucose: 229 mg/dl, Na: 147 mmol/L, K: 3.2 mmol/L, LDH: 570 and creatine kinase (CK) 92.
Sera, enemas and nasogastric tube were prescribed.
Neither enemas nor nasogastric tube were effective.
Ten hours later, the patient was in a preshock state.
Physical examination revealed lice in lower limbs and weakness of pedal pulses, heart rate of 120 bpm, blood pressure of 80/60.
Glucose: 430 mg/dl, amylase: 1,485 Ul/l, ALAT: 1,008 U/L, LDH: 8,102, CK: 8,310, POC-reactive protein: 32 mEq/ml
The CT scan showed a large gastric dilatation occupying most of the abdominal cavity with a hydro-aerial level and aortic compression.
The large gastric dilatation compresses the rest of the abdominal structures including the large vessels, aorta and cava and their branches, this is the cause of the low attenuation coefficient images identified in areas of ischemia of the pancreas and kidneys.
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Given the severity of the patient's condition, and the absence of improvement with conservative measures, a laparotomy and gastrotomy with food material was performed, finding a large amount of food unaware contained in the gastric chamber.
Two days later, a control CT scan was performed, which confirmed the significant decrease in the volume of the gastric chamber and the reestablishment of the caliber of the aorta, as well as the recovery of normal renal and pancreatic perfusion.
After 4 weeks of admission to the ICU, due to the existence of multiple organ failure in relation to hypoperfusion of abdominal viscerae given acute liver failure due to toxic-ischemic hepatitis, acute pancreatic perfusion syndrome and heavy pancreatic ischemia-ICU.
