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Sudden cardiac arrest due to acute gastric dilatation in a patient with an eating disorder
  1. S-C Kim,
  2. H-J Cho,
  3. M-C Kim,
  4. Y-G Ko
  1. Department of Emergency Medicine, College of Medicine, Kyung Hee University, Seoul, South Korea
  1. Dr H-J Cho, Kyung Hee University, # 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-701, South Korea; chohj327{at}hotmail.com

Abstract

Eating disorders are an important cause of physical and psychosocial morbidity in adolescent girls and young adult women. Although eating disorders have many medical complications, it is unclear which are responsible for the increased mortality. It should be emphasised that a number of different pathological processes are likely to be involved. Patients with eating disorders should be monitored carefully and should remain hospitalised. This can allow immediate emergency treatment to be performed when necessary because they could have a further cardiac arrest. A case of cardiac arrest is reported that was caused by gastric dilatation and elevated abdominal pressure, which were brought on by binge eating in a patient without intestinal obstruction.

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A 34-year-old woman was brought by ambulance to the emergency department because she had experienced 2 h of extreme abdominal pain and dyspnoea. Her vital signs included a body temperature of 36°C, a respiratory rate of 32 breaths per minute, a pulse rate of 144 beats per minute and a blood pressure of 140/90 mm Hg. Physical examination revealed marked abdominal distension with generalised muscle guarding. Five minute after presentation to the emergency department, we tried to perform an emergency ultrasound examination, but she suddenly had no breathing movements and her central pulse was undetectable. Continuous chest compressions at a rate of 100 per minute, endotracheal intubation, ventilation with 100% oxygen and intravenous volume expansion with saline were started. During chest compression, a large amount of vomitus was regurgitated. After 10 minutes of cardiopulmonary resuscitation, she returned to spontaneous circulation, with a blood pressure of 71/66 mm Hg. Chest and abdominal radiograph showed massive gastric dilatation. After stabilisation of her vital signs, a contrast enhanced chest and abdominal computed tomography scan was obtained (fig 1), which showed the huge dilatation of the oesophagus, stomach and duodenal bulb, which were filled with a great amount of undigested food material and air, along with tracheal compression and its anterior displacement by the distended oesophagus. Gastric lavage was then performed. A great amount of undigested food material and gastric gas was evacuated and her condition improved dramatically. Oesophagogastroduodenoscopy was performed after aspiration of the gastric contents in the intensive care unit for 2 days. The oesophagogastroduodenoscopy findings were multiple benign gastric ulcers. She was discharged in good condition with instructions to follow-up with the departments of internal medicine and psychiatry.

Figure 1 Scout film shows severe gastric dilatation in the entire abdomen and inserted endotracheal tube.

DISCUSSION

There is general agreement that the most common cause of death in eating disorders is serious starvation with cachexia; this leads to both metabolic and cardiovascular collapse. Nutritional complications, electrolyte imbalance and dehydration may also be relevant. A number of possible causes for acute gastric dilatation occurring in patients with anorexia nervosa have been suggested: increased feeding after a period of relative starvation; nervous inhibition of gastric emptying; hypokalaemia; the neurogenic complications of malnourishment; psychogenic factors and phenothiazines.1 Death as a result of binge eating in a patient with an eating disorder has been described; an autopsy showed a markedly distended stomach that contained approximately 6500 ml of solid food. The cause of death was thus diagnosed as intestinal obstruction due to an excessive volume of food.2 In addition, the superior mesenteric artery syndrome and acute gastric dilatation in patients with eating disorders have been described.3 4 However, our case showed no intestinal obstruction and the collapsed inferior vena cava and peripheral displacement of the bowel loops were caused by the severely distended stomach with food material and gas. The possible causes of cardiac arrest in our case were a decreased preload due to left atrial and inferior vena cava collapse and the respiratory difficulty that was caused by elevated abdominal pressure.

CONCLUSION

We conclude that conservative therapy may still be acceptable for a patient such as we have reported here, and even for patients with severe acute abdominal pain and abdominal distension, but patients with eating disorders should be monitored carefully and they should remain hospitalised. This can allow immediate emergency treatment to be performed when necessary because they could have a further cardiac arrest.

REFERENCES

Footnotes

  • Competing interests: None.

  • Patient consent: Obtained.

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