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Acute gastric dilatation is scarcely reported in the literature. Gastric necrosis is extremely uncommon due to the rich blood supply of the stomach. A rare complication of eating disorders is the acute gastric dilatation with necrosis. However, it can occur after large intake of food over a short period of time (1-3). We report a case of a 36 year-old woman that arrived at the emergency room with a sudden onset of epigastric pain that had generalized throughout the abdomen. The patient had had a large intake of food 24 hours before admission. On examination, she was hemodynamically stable, showing a painful, tympanic, and distended abdomen, with signs of peritoneal irritation. The complete blood count revealed neutrophilic leukocytosis without electrolytic disorders. Abdominal X-ray and abdominal CT scan revealed a massive and dilated stomach occupying from the diaphragm to the iliac bone (Fig. 1). Initial treatment included fluid therapy, analgesia and placement of nasogastric tube. Given the progressive clinical deterioration of the patient, emergency surgery was performed. A massive gastric distension was observed, along with extensive necrosis of the posterior wall and gastric fundus, and patchy necrosis throughout the greater curvature (Fig. 2). The patient underwent total gastrectomy and esophagojejunostomy. The patient was assessed by psychiatrists and admitted for treatment of the eating disorder and was discharged without complications. The total gastrectomy specimen was massively dilated and necrotic, measuring 40 cm along the greater curvature and 11 cm along the lesser curvature. Acute gastric dilation with necrosis has been described in re-feeding after starvation, diabetes mellitus, bezoars, gastrointestinal tumours, gastric volvulus, gastroduodenal Crohn’s disease, etc. (4). Patients with anorexia nervosa and bulimia nervosa have altered gastric motility in approximately 60% of the cases, which makes them prone to developing severe gastric dilatation (5). Initial treatment with nasogastric tube decompression normally obtains satisfactory results. The use of the endoscope is scant because the gastric contents are usually too dense to be drawn out and there is also a high risk of perforation (6).

Acute gastric dilatation in the context of bulimia nervosa