Tokumitsu Keita, Hatoyama Keiichiro, Kubota Yuka, Asami Kengo, Ohsato Masayuki, Okamoto Michitaka, Takeuchi Junko, Yachimori Koji
Seishin Shinkeigaku Zasshi. 2016;118(5):275-280.
In the present case, the subject was a 31-year-old woman with obesophobia who restricted her energy intake and repeatedly induced vomiting and misused laxatives after binge eating, which caused a sudden weight loss of 29 kg in approximately 5 months. In January 20XX, the subject was first examined as an outpatient at our psychiatric department at the recommendation of her eldest son. Upon diagnosis of anorexia nervosa, the subject underwent outpatient treatment ; however, there was no improvement in the disturbance in self-per- ceived weight or shape, and the subject voiced her desire to lose weight. In May 20XX, the subject complained of chest pain, pharyngeal pain, and respiratory distress after self-induced vomiting and was, thus, examined at the psychiatric outpatient services. Chest X-ray and chest CT revealed pneumomediastinum and subcutaneous emphysema. Spontaneous oesophageal rupture, a fatal condition, was suspected and, therefore, the subject was transferred to a more advanced medical institution capable of esophageal surgery. After admission, spontane- ous oesophageal rupture was ruled out based on the results of upper gastrointestinal endos- copy with esophagography, and spontaneous pneumomediastinum was diagnosed. The pneu- momediastinum disappeared with conservative treatment ; however, after approximately 8 months, spontaneous pneumomediastinum recurred, following self-induced vomiting. For patients with eating disorders and who are involved in self-induce vomiting, we believe that the vomiting can cause pneumomediastinum, and it is assumed that continuation or recommencement of vomiting can potentially increase the risk that pneumomediastinum will recur. We, therefore, report recurring pneumoediastinum as a physical complication caused by self- induced vomiting that should be noted in clinical practice of the psychiatric department.
在本病例中，患者为一名31岁患有恐胖症的女性，她限制能量摄入，在暴饮暴食后反复催吐并滥用泻药，导致在大约5个月内体重突然减轻了29千克。20XX年1月，在其长子的建议下，该患者首次到我院精神科门诊就诊。经诊断为神经性厌食症后，患者接受了门诊治疗；然而，其对自身体重和体型认知的紊乱并未改善，且患者仍表示希望减肥。20XX年5月，该患者在自我催吐后出现胸痛、咽痛和呼吸窘迫，因此到精神科门诊就诊。胸部X线和胸部CT检查显示纵隔气肿和皮下气肿。怀疑为自发性食管破裂这一致命病症，因此该患者被转至一家能够进行食管手术的更高级医疗机构。入院后，根据上消化道内镜检查及食管造影结果排除了自发性食管破裂，诊断为自发性纵隔气肿。经保守治疗纵隔气肿消失；然而，大约8个月后，在自我催吐后自发性纵隔气肿复发。对于患有饮食失调且有自我催吐行为的患者，我们认为催吐可导致纵隔气肿，并且推测继续催吐或再次开始催吐可能会增加纵隔气肿复发的风险。因此，我们报告复发性纵隔气肿是一种由自我催吐引起的躯体并发症，在精神科临床实践中应予以注意。
