Gastric Necrosis Caused by Acute Gastric Dilatation after an Episode of Bulimia -A Case Report-

Masahiro Usuda, Masanori Koizumi, Hiroyuki Kouda, Chihiro Nakahara, Hamaichi Ueki, Shingo Shibazaki*

Department of Surgery, Mito National Hospital
*Department of Pathology, Mito National Hospital

We report a case of gastric necrosis caused by acute gastric dilatation after an episode of bulimia. A 66-year-old man entered Mito National Hospital with complaints of progressive abdominal pain and distention. He had been in another hospital for treatment of a psychiatric disease. The gas within the gastric wall was observed as lines of bubbles on plain films. Bubbles within the gastric wall, gas within the portal vein in the liver and massive gastric dilatation were observed on CT scans. Although no episode of bulimia before the onset was known, the findings of x-ray and CT confirmed the bulimia and the diagnosis of gastric necrosis caused by gastric distention. An emergency laparotomy was performed. Much ingested food was in the stomach and almost the whole gastric mucosa was necrotic except part of the antrum. Total gastrectomy and Roux-Y esophagojejunostomy were performed. Patients suffering from psychiatric disease with severe abdominal pain and distension may suffer from gastric necrosis after bulimia, although it is definitely uncommon. For the diagnosis, x-ray and CT scanning are very valuable.

Key words
gastric necrosis, gastric dilatation, bulimia

Reprint requests
Masahiro Usuda The Second Department of Surgery, Tohoku University School of Medicine
1-1 Seiryou-machi, Aoba-ku, Sendai, 980-0872 JAPAN

Accepted
September 16, 1998

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