1 - Serviço de Cirurgia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- Apresentação no mesa “Os melhores” na 8ª Reunião da EUSPP/23º Congresso da SPCP – Urgência e Emergência Pediátrica, Évora.
- Prémio de melhor comunicação oral.
Introduction: Acute gastric distension (AGD) is a well-known complication of bulimia, which occurs when the already diseased stomach expands rapidly due to the consumption of large amounts of food in a short period of time. In severe cases, AGD can lead to gastric rupture or severe electrolyte imbalances.
Clinical case: A 14-year-old girl presents to the ED with complaints of 48h of vomiting and bloating. The patient was distended, with a tympanized abdomen and pain in the upper quadrants. Blood work and abdominal x-ray was normal. The vomiting persisted; an NG tube was placed without any drainage. Abdominal CT-scan showed an extremely dilated stomach, compatible with a bezoar. The patient wasn’t improving with conservative therapy and the decision to operate was made. Surgical findings were a distended stomach with food-content (no signs of bezoar), disperse small intestine lymphangiectasy, no signs of intrinsic or extrinsic gastric outlet obstruction or signs of intestinal obstruction, no bowel adhesions. The stomach was decompressed, and biopsies were collected. An investigation to establish an etiology was initiated: normal abdominal echography; normal abdominal MRI; gastric and mesenteric ganglia biopsies were negative. A few moments of severe bradycardia during in-patient time were detected, and an eating disorder was suspected. After 7 days pos-op, the patient confessed to binge and purging behaviors during the last 6 months.
Discussion: AGD is a serious medical complication associated with bulimia. It occurs when the stomach expands rapidly due to the accumulation of content causing severe abdominal complaints. AGD can lead to gastric rupture, which is a life-threatening emergency that requires immediate surgical intervention. It’s a rare complication, but it is a well-documented in the literature. In most cases, can be managed conservatively but in some severe cases, surgical intervention may be necessary.
Conclusion:AGD is a serious complication associated with bulimia that can lead to life-threatening emergencies, such as gastric rupture. Early detection and intervention can reduce the risk of developing this condition and other serious medical complications.
Palavras Chave: Binge eating, Bulimia, Distensão gástrica, tratamento cirúrgico