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A 36-year-old-woman with type 1 diabetes mellitus presented with a one-day history of diffuse abdominal pain, watery loose motions, vomiting and nausea. These symptoms were preceded by a bout of enormous food intake. There was no history of substance abuse or toxic drug intake. Clinically she had a massively distended abdomen and was in severe respiratory distress; femoral pulses were absent. Plain radiograph of the abdomen showed a massively distended stomach extending into the pelvis (fig 1). Computed tomography and ultrasound of the abdomen revealed displaced intestines, compressed aorta and mesenteric veins. An urgent laparotomy revealed an enormously distended stomach without obstruction, adhesions or volvulus. Gastrotomy and nasogastric suction led to the removal of 9 litres of gastric contents. Following gastric decompression the mesenteric and femoral pulses returned to normal. She made an uneventful recovery. She had a history of bulimia and a binge eating disorder. Acute gastric dilatation is a known life-threatening complication of anorexia nervosa and bulimia.
Competing interests: None.
Ethics approval: Ethics approval was obtained.
Patient consent: Obtained.