Gastric dilatation and perforation due to binge eating: a case report

We present a case of massive gastric dilatation and necrosis in a patient with psychogenic polyphagia. The patient developed a Candida albicans sepsis due to gastric perforation and was treated with antifungal therapy and multiple surgical interventions. Case A 43-year-old female attended the emergency department with complaints of severe abdominal pain. The pain, mainly localized in the epigastric area, arose after the ingestion of a large amount of food one day prior to admission. The patient was suffering from nausea but was unable to vomit. She was afebrile and did not complain of altered bowel movements. Her medical history reported a lumbar sympathectomy, psychosis and an eating disorder (periods of polyphagia alternated with periods of extreme anorexia). An erect abdominal X-ray ( figure 1 ) showed a remarkably distended stomach. The patient was admitted to the surgical ward with the suspected diagnosis of gastric distension, possibly caused by delayed gastric emptying provoked by her anti-psychotic drugs, namely Olanzapine and Clomipramine. She was put on ‘nil by mouth’ and was given a nasogastric tube, which immediately drained 2.5 litres of gastric fluid. However, in the next few hours the patient’s condition deteriorated, showing signs of shock with progressive tachypnoea, tachycardia, cold extremities and falling blood pressure. At emergency laparotomy, the ventral side of the stomach was found to be completely necrotic and had perforated from the distal oesophagus to the pylorus. Further, 3.5 litres of gastric fluid and undigested food particles had leaked into the abdominal cavity. Extensive abdominal lavage was performed, followed by resection of the necrotic ventral side with reconstruction of a “tube-like” stomach, using the vital dorsal side of the stomach.