Klinik für Gastroenterologie, Allgemeines Krankenhaus Celle, Celle, Germany.
Z Gastroenterol. 2022 Jul;60(7):1118-1123. doi: 10.1055/a-1649-8131. Epub 2021 Nov 24.
Acute gastric dilatation is a rare and potentially life-threatening condition that may occur in patients suffering from anorexia nervosa after ingesting large amounts of food within a short period. Frequently, this condition is considered a surgical emergency due to subsequent occurrence of complications such as gastric necrosis or perforation.Here we report a case of a young female patient (23 years) with anorexia nervosa who presented with severe abdominal pain, nausea, and inability to vomit after a period of binge eating. Abdominal computed tomography revealed an extremely dilated stomach measuring 39.0 cm × 18.0 cm in size. Initial nasal decompression therapy using gastric tubes had failed. Due to the absence of complications, it was decided to treat her solely by endoscopic means under mechanical ventilation. After undergoing multiple overtube-assisted esophagogastroduodenoscopies (EGDs), she fully recovered eventually.This case demonstrates that interventional endoscopic treatment of a patient with uncomplicated acute gastric dilatation is feasible and safe, at least under general anesthesia. Hence, this option should be considered when sole gastric tube suction fails, and there is no indication of complications such as peritonitis, sepsis, perforation, or gastric ischemia. A more invasive and aggressive surgical procedure may be avoided in selected cases, and the length of hospital stay may be shortened.
急性胃扩张是一种罕见且可能危及生命的疾病，可能发生在在短时间内摄入大量食物的神经性厌食症患者中。由于随后可能发生胃坏死或穿孔等并发症，这种情况通常被视为外科急症。在此，我们报告一例年轻女性神经性厌食症患者，在暴食后出现严重腹痛、恶心和无法呕吐。腹部 CT 显示胃极度扩张，大小为 39.0cm×18.0cm。最初使用胃管进行鼻减压治疗失败。由于没有并发症，决定仅在机械通气下通过内镜进行治疗。在多次使用过管辅助食管胃十二指肠镜检查（EGD）后，她最终完全康复。本病例表明，对于无并发症的急性胃扩张患者，介入性内镜治疗是可行且安全的，至少在全身麻醉下如此。因此，在单纯胃管抽吸失败且无腹膜炎、败血症、穿孔或胃缺血等并发症迹象时，应考虑这种选择。在某些情况下，可以避免更具侵袭性和攻击性的手术程序，并缩短住院时间。
