1
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Perogio M, Simonit F, Da Broi U, Desinan L. Manner of death determination in a case of gastric mucosal tears. Leg Med (Tokyo) 2024; 66:102367. [PMID: 38039656 DOI: 10.1016/j.legalmed.2023.102367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 11/23/2023] [Indexed: 12/03/2023]
Abstract
Gastric tears are rarely described in the forensic pathological literature, although they can lead to a fatal acute exsanguination. Such lesions can arise from several conditions leading to an increased intragastric pressure, such as Mallory Weiss syndrome, cardiopulmonary resuscitation, acute barotrauma and operative procedures, showing peculiar morphological features. We present a case of a 32-year-old drug addicted white woman found dead in a pool of blood in the house of her drug dealer, after taking a dose of intravenous heroin. At autopsy, abundant bloody gastric content and multiple and long gastric tears, extending from the cardias and fundus regions to the gastric corpus were observed; one of them involved the subserous region, resulting in a gastric wall rupture. The victim had no history of recent vomiting and of gastro-intestinal pathologies. Drugs and ethanol levels detected in the specimens of the victim were not consistent with lethal concentrations, thus the death was attributed to acute exsanguination. After reviewing the literature, it turned out that morphological aspects of the gastric tears, such as number, size and topographical distribution, observed at autopsy were atypical compared to those of typical gastric lacerations.
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Affiliation(s)
- Maurizio Perogio
- Department of Medical, Surgical and Health Sciences, School of Legal Medicine, University of Trieste, Trieste, Italy.
| | - Francesco Simonit
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
| | - Ugo Da Broi
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
| | - Lorenzo Desinan
- Department of Medicine, Legal Medicine, University of Udine, Udine, Italy
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2
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Almarri NT, Elsaadawy RJ, Alhumaidan AM. Acute Gastric Ischemia in a Case of Small Bowel Obstruction. Cureus 2024; 16:e55113. [PMID: 38558711 PMCID: PMC10979248 DOI: 10.7759/cureus.55113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2024] [Indexed: 04/04/2024] Open
Abstract
Gastric ischemia is a relatively rare condition that can lead to severe or life-threatening outcomes. It can be caused by various etiological factors, including vascular occlusion, atherosclerosis, vasculitis, hypovolemic shock, cardiac failure, mesenteric ischemia, splanchnic vasoconstriction, and abdominal compartment syndrome. Furthermore, gastric dilation can be caused by volvulus and acute necrotizing gastritis. This condition may go unnoticed in the setting of intestinal obstruction. In this case report, we describe a 43-year-old female who presented with signs, symptoms, and radiological findings indicative of small bowel obstruction accompanied by a severely dilated stomach. Our aim is to highlight the importance of considering gastric ischemia in patients with small bowel obstruction and to demonstrate the outcomes of a surgical approach in such presentations.
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3
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Lee LM, Owens LA, Krugner-Higby LA, Graham M, Simmons HA, Climans M, Brown K, Bennett AJ, Schaefer J, Meyer K, Goldberg TL. Sarcina sp. as a presumptive cause of fatal acute gastric dilation and gastric emphysema in rhesus macaques. J Vet Diagn Invest 2023; 35:698-703. [PMID: 37646249 PMCID: PMC10621543 DOI: 10.1177/10406387231193965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
A 4-y-old female and 3-y-old male rhesus macaque (Macaca mulatta), both housed in the same facility, died unexpectedly within 2 wk. Postmortem examination revealed severe gastric dilation in both macaques and gastric emphysema in the female macaque. Histologically, bacteria consistent with Sarcina sp. were present in both macaques within the lungs and lumen of the trachea, esophagus, and gastrointestinal (GI) tract without associated inflammation. Additionally, in the female macaque, the bacteria were found in the gastric mucosa and associated with emphysematous spaces in the gastric wall without associated inflammation. PCR and Sanger sequencing of amplicons were subsequently performed on GI contents and non-alimentary tissues from the 2 affected monkeys and on comparative samples from unaffected rhesus monkeys in the same facility and an adjacent primate facility. The cases were compared using the 2-tailed Fisher exact test (p-value at 95% confidence). PCR identified Sarcina in GI contents of both affected and unaffected monkeys (p = 0.6084) and in non-alimentary tissues of affected monkeys only (p = 0.0083). These results suggest that the presence of Sarcina sp. in non-alimentary tissues is associated with gastric distension, gas accumulation, and unexpected death in nonhuman primates.
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Affiliation(s)
- Laura M. Lee
- Department of Pathobiology, Auburn University, College of Veterinary Medicine, Auburn, AL, USA
- Research Animal Resources and Compliance, University of Wisconsin–Madison, Madison, WI, USA
| | - Leah A. Owens
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
| | - Lisa A. Krugner-Higby
- Research Animal Resources and Compliance, University of Wisconsin–Madison, Madison, WI, USA
| | - Melissa Graham
- Research Animal Resources and Compliance, University of Wisconsin–Madison, Madison, WI, USA
- Department of Agriculture, Trade and Consumer Protection, State of Wisconsin, Madison, WI, USA
| | - Heather A. Simmons
- Wisconsin National Primate Research Center, University of Wisconsin–Madison, Madison, WI, USA
| | - Megan Climans
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
| | - Kelsey Brown
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
| | - Allyson J. Bennett
- Harlow Center for Biological Psychology, University of Wisconsin–Madison, Madison, WI, USA
| | - Jennifer Schaefer
- Harlow Center for Biological Psychology, University of Wisconsin–Madison, Madison, WI, USA
| | - Kyle Meyer
- Harlow Center for Biological Psychology, University of Wisconsin–Madison, Madison, WI, USA
| | - Tony L. Goldberg
- Department of Pathobiological Sciences, School of Veterinary Medicine, University of Wisconsin–Madison, Madison, WI, USA
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4
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Wiedbrauck D, Wiedbrauck F, Hollerbach S. Endoscopic management of giant gastric dilatation in an anorexia nervosa patient after binge eating. ZEITSCHRIFT FUR GASTROENTEROLOGIE 2021; 60:1118-1123. [PMID: 34820803 DOI: 10.1055/a-1649-8131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
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.
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Affiliation(s)
- Damian Wiedbrauck
- Klinik für Gastroenterologie, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Felix Wiedbrauck
- Klinik für Gastroenterologie, Allgemeines Krankenhaus Celle, Celle, Germany
| | - Stephan Hollerbach
- Klinik für Gastroenterologie, Allgemeines Krankenhaus Celle, Celle, Germany
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5
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Gibson D, Watters A, Mehler PS. The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic?-A systematic review. Int J Eat Disord 2021; 54:1019-1054. [PMID: 34042203 DOI: 10.1002/eat.23553] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 04/22/2021] [Accepted: 05/08/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood. This systematic review seeks to better understand how these physiologic changes of malnutrition of the esophagus, stomach, intestines, and pancreas contribute toward the reported GI symptoms, as well as better understand how celiac disease, inflammatory bowel disease, pelvic floor dysfunction, and Ehlers-Danlos syndrome contribute toward disordered eating. METHODS Studies of any design exploring the pathogenesis of complications and treatment strategies were included. Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used to structure and complete the review. RESULTS A total of 146 articles were used for the review. The majority of studies were observational or case reports/case series. DISCUSSION Pathophysiologic changes of the esophagus, stomach, and intestines develop with malnutrition, although these changes do not consistently correlate with expressed GI symptoms in patients with restrictive eating disorders. Celiac disease and inflammatory bowel disease also contribute to disordered eating through the associated somatic GI complaints, while pelvic floor dysfunction and Ehlers-Danlos syndrome contribute through both somatic symptoms and functional symptoms. Indeed, functional GI symptoms remain problematic during the course of treatment, and further research is required to better understand the extent to which these symptoms are functional in nature and remit or remain as treatment ensues.
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Affiliation(s)
- Dennis Gibson
- ACUTE at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Ashlie Watters
- ACUTE at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Philip S Mehler
- ACUTE at Denver Health, Denver, Colorado, USA.,Department of Medicine, University of Colorado School of Medicine, Aurora, Colorado, USA.,Eating Recovery Center, Denver, Colorado, USA
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6
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Craven A, Foo J, Sweeney T. Acute gastric dilation and necrosis from binge eating in anorexia nervosa. ANZ J Surg 2020; 90:2133-2135. [PMID: 32100407 DOI: 10.1111/ans.15780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Alexander Craven
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Jonathan Foo
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
| | - Thomas Sweeney
- Department of General Surgery, Austin Health, Melbourne, Victoria, Australia
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7
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Riedlinger C, Schmidt G, Weiland A, Stengel A, Giel KE, Zipfel S, Enck P, Mack I. Which Symptoms, Complaints and Complications of the Gastrointestinal Tract Occur in Patients With Eating Disorders? A Systematic Review and Quantitative Analysis. Front Psychiatry 2020; 11:195. [PMID: 32425816 PMCID: PMC7212454 DOI: 10.3389/fpsyt.2020.00195] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Eating disorders (ED) such as anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) are often accompanied by a variety of psychological and physical comorbidities. Gastrointestinal (GI) symptoms are a classical feature in most patients with ED. The heterogeneity of studies on this topic is high, making it difficult to have a clear overview. The aim of this systematic review is therefore to provide an overview of subjectively and objectively measured differences and changes in the GI tract in patients with EDs, along with the occurrence of GI complications. METHODS A systematic literature search was conducted in PubMed, Web of Science, and Google Scholar to find all relevant studies examining GI problems in AN, BN, and BED. Quantitative analyses were performed for objective GI physiology measures where applicable. RESULTS The review differentiated between ED types and also between studies that report GI outcomes of ED in (i) human studies with an ED diagnosis excluding case reports that provide an overview of GI problems in ED and (ii) case reports with an ED diagnosis describing rare GI complications in ED. GI symptoms and impaired gastric transit times were frequent features of EDs with specific differences found for the ED types. During the time course of treatment, GI symptoms changed and/or improved but not completely. GI complications extended the range of GI problems observed, including a variety of serious complications such as gastric dilatation. CONCLUSIONS Problems of the GI tract are frequent in patients with ED and it is likely that they complicate therapy, especially in patients with AN. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42019100585.
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Affiliation(s)
- Caroline Riedlinger
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Greta Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Alisa Weiland
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Andreas Stengel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Katrin Elisabeth Giel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Stephan Zipfel
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Paul Enck
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
| | - Isabelle Mack
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Tübingen, Tübingen, Germany.,Competence Center for Eating Disorders (KOMET), Tübingen, Germany
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8
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Schalla MA, Stengel A. Gastrointestinal alterations in anorexia nervosa - A systematic review. EUROPEAN EATING DISORDERS REVIEW 2019; 27:447-461. [DOI: 10.1002/erv.2679] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 02/20/2019] [Accepted: 03/15/2019] [Indexed: 12/13/2022]
Affiliation(s)
- Martha A. Schalla
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
| | - Andreas Stengel
- Charité Center for Internal Medicine and Dermatology, Department for Psychosomatic Medicine; Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Berlin Germany
- Department of Psychosomatic Medicine and Psychotherapy; Medical University Hospital Tübingen; Tübingen Germany
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9
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Madea B, Doberentz E. Commentary on: Di Luca A, Ricci E, Grassi VM, Arena V, Oliva A. An exceptional case of acute respiratory failure caused by intrathoracic gastric perforation secondary to overeating. J Forensic Sci 2019;64(1):292–4. J Forensic Sci 2019; 64:965-966. [DOI: 10.1111/1556-4029.14059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Burkhard Madea
- Institute of Forensic Medicine of the University of Bonn Stiftsplatz 12 D‐53111 Bonn Germany
| | - Elke Doberentz
- Institute of Forensic Medicine of the University of Bonn Stiftsplatz 12 D‐53111 Bonn Germany
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10
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Shimada M, Hirose Y, Shimizu K, Yamamoto DS, Hayakawa EH, Matsuoka H. Upper gastrointestinal pathophysiology due to mouse malaria Plasmodium berghei ANKA infection. Trop Med Health 2019; 47:18. [PMID: 30872946 PMCID: PMC6399856 DOI: 10.1186/s41182-019-0146-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/20/2019] [Indexed: 12/11/2022] Open
Abstract
Background Epigastric pain, vomiting, and other gastrointestinal problems are among the most important symptoms of malaria infection as they suggest the possibility that the condition is serious. Pathophysiologies such as gastric mucosal changes and delayed gastric emptying have been reported in serious cases of malaria infection. However, it is unclear whether or not pathophysiological involvement of the upper gastrointestinal tract occurs in Plasmodium berghei ANKA (PbA)-infected mice. Methods PbA-infective Anopheles mosquitoes were used to infect mice via the natural route of infection. Fifteen PbA-C57BL/6 mice were used as a cerebral malaria model and the same numbers of PbA-BALB/c mice were used as a cerebral malaria-resistant model, and then we investigated the pathophysiological involvement of the stomach and small intestine. Results On day 8 post infection, six PbA-C57BL/6 mice showed cerebral malaria and nine others had uncomplicated infection. All the PbA-C57BL/6 mice on that same day showed severe weight loss with multiple, red gastric patches and changes to the course of the small intestine with villus goblet cell enlargement. In addition, cerebral malaria cases showed gastric gas retention with submucosal edema and small intestinal shortening. In PbA-BALB/c mice, overextension of the stomach and gas retention were evident from week 2 after PbA infection, as well as changes to the course of the small intestine and mesenteric thinning with fragility. Conclusions We described the upper gastrointestinal pathophysiology representing new findings directly linked to malarial severity and subsequent death in PbA-infected mice as a mouse model of malaria infection.
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Affiliation(s)
- Mizuho Shimada
- 1Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke City, Tochigi 329-0498 Japan
| | - Yoshie Hirose
- 2Department of Pathology, Ashikaga Red Cross Hospital, 284-1, Yobe-cho, Ashikaga City, Tochigi 326-0843 Japan
| | - Kazuhiko Shimizu
- 2Department of Pathology, Ashikaga Red Cross Hospital, 284-1, Yobe-cho, Ashikaga City, Tochigi 326-0843 Japan
| | - Daisuke S Yamamoto
- 1Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke City, Tochigi 329-0498 Japan
| | - Eri H Hayakawa
- 1Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke City, Tochigi 329-0498 Japan
| | - Hiroyuki Matsuoka
- 1Division of Medical Zoology, Department of Infection and Immunity, Jichi Medical University, 3311-1, Yakushiji, Shimotsuke City, Tochigi 329-0498 Japan
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11
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Murakami C, Irie W, Sasaki C, Nakamaru N, Sakamoto M, Nagato J, Satoh F. Extensive gastric necrosis secondary to acute gastric dilatation: A case report. Leg Med (Tokyo) 2018; 36:85-88. [PMID: 30448603 DOI: 10.1016/j.legalmed.2018.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/09/2018] [Accepted: 11/12/2018] [Indexed: 12/31/2022]
Abstract
We report a case of sudden death in a patient who developed extensive gastric necrosis secondary to acute gastric dilatation. A 36-year-old man with mental retardation (but without difficulties in activities of daily living), developed an illness after a meal out with friends, necessitating 3 hospital visits. He returned home after receiving drug therapy; however, his condition deteriorated, and he was transferred to our hospital via ambulance. Whole-body computed tomography performed upon admission revealed gastric dilatation. A stomach tube was inserted, and 2000 mL of gastric aspirate was obtained. The patient died approximately 5 h later despite receiving treatment. Autopsy revealed 1000 mL of gastric contents and extensive gastric necrosis. He was diagnosed with extensive gastric necrosis secondary to acute gastric dilatation.
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Affiliation(s)
- Chikako Murakami
- Department of Legal Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan.
| | - Wataru Irie
- Department of Legal Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Chizuko Sasaki
- Department of Legal Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Naomi Nakamaru
- Department of Legal Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Momoko Sakamoto
- Department of Legal Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Junpei Nagato
- Department of Legal Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
| | - Fumiko Satoh
- Department of Legal Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan
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12
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Intestinal obstruction as a cause of death in the mentally disabled. Forensic Sci Med Pathol 2018; 15:136-139. [PMID: 30076536 DOI: 10.1007/s12024-018-0007-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 10/28/2022]
Abstract
Two cases of intestinal obstruction in the mentally disabled are reported. The first case concerns 61-year-old oligophrenic woman who resided in a nursing home, where she was found hypotensive and unresponsive. Upon opening the peritoneal cavity at autopsy, extremely dilated (measuring on average 12 cm in diameter) loops of the colon emerged- they compressed the small intestine and other intraperitoneal organs, lifting both hemidiaphragms deep into the pleural cavity. Lodged firmly into the rectum, a partly disintegrated sanitary pad was found. In the second case, young man with Down syndrome was found dead in his room in a nursing facility. At autopsy, a massively dilated stomach and intestinal loops emerged, interposing one of the loops between the liver and right hemidiaphragm (pushing it to the 3rd intercostal space). This was caused by a volvulus - the cecum, the entire ascending colon and hepatic flexure were gangrenous, dilated (the maximum diameter was 15 cm) and twisted in a full circle around the mesenteric attachment. There were no signs of colon perforation. In both cases, intellectual disability was at the core of poor communication and delayed medical treatment, which led to a fatal outcome. Caregivers must be trained to recognize distress in the mentally disabled, especially since the symptoms and signs of gastrointestinal diseases may be subtle, or at least less recognizable. By performing careful physical examination medical staff should search more cautiously for these signs. Any suspicion of mistreatment or neglect of the mentally impaired requires a medico-legal investigation and autopsy.
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13
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Schmidt-Wilcke P, Schubert S, Knorr S, Wilhelm T. Akutes Abdomen einer Bulimiepatientin. Chirurg 2018; 89:59-62. [DOI: 10.1007/s00104-017-0518-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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14
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Menezes RG, Ahmed S, Pasha SB, Hussain SA, Fatima H, Kharoshah MA, Madadin M. Gastrointestinal causes of sudden unexpected death: A review. MEDICINE, SCIENCE, AND THE LAW 2018; 58:5-15. [PMID: 29141499 DOI: 10.1177/0025802417737001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Gastrointestinal conditions are a less common cause of sudden unexpected death when compared to other conditions such as cardiovascular conditions, but they are equally important. Various congenital and acquired gastrointestinal conditions that have resulted in sudden unexpected death are discussed. The possible lethal mechanisms behind each condition, along with any associated risk factors or secondary diseases, have been described. Through this article, we aim to highlight the need for physicians to prevent death in such conditions by ensuring that subclinical cases are diagnosed correctly before it is too late and by providing timely and efficacious treatment to the patient concerned. In addition, this review would certainly benefit the forensic pathologist while dealing with cases of sudden unexpected death due to gastrointestinal causes. This article is a review of the major gastrointestinal causes of sudden unexpected death. In addition, related fatal cases encountered occasionally in forensic autopsy practice are also included. There are several unusual and rare causes of life-threatening gastrointestinal bleeding that may lead to sudden unexpected death to cover all the entities in detail. Nevertheless, this article is a general guide to the topic of gastrointestinal causes of sudden unexpected death.
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Affiliation(s)
- Ritesh G Menezes
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (KSA)
| | - Saba Ahmed
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Bilal Pasha
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Ather Hussain
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Huda Fatima
- 2 Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Mohammed Madadin
- 1 Forensic Medicine Division, Department of Pathology, College of Medicine, King Fahd Hospital of the University, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia (KSA)
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15
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Abstract
This report is related to the unusual case of an 11-year-old boy presenting with acute gastric dilatation after the intake of excessive food and carbonated beverages after a 12-hour fasting who died of complications of acute reperfusion syndrome after decompression of the stomach with gastrotomy. An enormously distended stomach was encountered without volvulus and obstruction in the operation. Autopsy and histological findings revealed a severely distended stomach, the walls of which were notably thin and displayed transmural necrosis. The reported case demonstrated that enormous food and beverage intake may cause acute gastric dilatation and gastric necrosis, and subsequently, sudden death may develop in children. The subject reported here is the youngest child in literature dying from acute gastric dilatation and necrosis without any underlying disorders and exposed to autopsy.
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16
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Stringer R, Schrader M. Acute Idiopathic Gastric Distension Causing Atrioventricular Block and Cardiogenic Shock. J Emerg Med 2017; 53:302-305. [PMID: 28602457 DOI: 10.1016/j.jemermed.2017.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Revised: 03/28/2017] [Accepted: 04/05/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND We report a rare case of acute idiopathic gastric dilatation with associated severe bradycardia and shock. CASE REPORT A 69-year-old woman presented to the emergency department (ED) with complaint of chest pain and dyspnea. The patient required transvenous cardiac pacing for profound bradycardia and cardiogenic shock. After a negative emergent cardiac catheterization, a flat plate abdominal x-ray study demonstrated massive gastric dilatation, prompting nasogastric tube placement, with subsequent rapid improvement of the patient's cardiovascular and metabolic instability. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case highlights the rare though potentially catastrophic complications of acute gastric dilatation, and benefits of early intervention with gastric decompression.
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Affiliation(s)
- Ryan Stringer
- Lakeland Healthcare Emergency Medicine Residency, Michigan State University College of Osteopathic Medicine, St. Joseph, Michigan
| | - Megan Schrader
- Lakeland Healthcare Emergency Medicine Residency, Michigan State University College of Osteopathic Medicine, St. Joseph, Michigan
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Abstract
PURPOSE To gain further understanding of the general medical comorbidity of binge eating disorder (BED) beyond its association with obesity. METHOD We reviewed studies of general medical comorbidity in people with BED or clinically significant binge eating behavior beyond obesity. We also reviewed studies of BED in specific medical conditions. RESULTS Three broad study categories of medical comorbidity in BED were found: cross-sectional studies of medical conditions in BED; prospective studies of medical conditions in BED; and studies of BED in specific medical conditions. Cross-sectional epidemiologic data suggest that BED is associated with medical conditions related to obesity, including diabetes, hypertension, dyslipidemias, sleep problems/disorders, and pain conditions, and that BED may be related to these conditions independent of obesity and co-occurring psychiatric disorders. Prospective data suggest that BED may be associated with type 2 diabetes and metabolic syndrome. BED or binge eating behavior is also associated with asthma and gastrointestinal symptoms and disorders, and among women, menstrual dysfunction, pregnancy complications, intracranial hypertension, and polycystic ovary syndrome. CONCLUSIONS BED is associated with substantial medical comorbidity beyond obesity. Further study of the general medical comorbidity of BED and its relationship to obesity and co-occurring psychiatric disorders is greatly needed.
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Panach-Navarrete J, Moro-Valdezate D, Garcés-Albir M, Barreda-Estuardo L, Bosca-Watts MM, Ortega-Serrano J. Acute gastric dilatation in the context of bulimia nervosa. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2016; 107:580-1. [PMID: 26334471 DOI: 10.17235/reed.2015.3673/2015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Norris ML, Harrison ME, Isserlin L, Robinson A, Feder S, Sampson M. Gastrointestinal complications associated with anorexia nervosa: A systematic review. Int J Eat Disord 2016; 49:216-37. [PMID: 26407541 DOI: 10.1002/eat.22462] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE A systematic review identifying gastrointestinal (GI) complications attributable to anorexia nervosa (AN) was completed. METHOD Studies of any design exploring the pathogenesis of complications and treatment strategies were included. The review was completed in accordance with PRISMA standards. RESULTS A total of 123 articles were retained, including one randomized control trial. The majority of included studies were case reports and case series. Controlled studies demonstrated that patients with AN were more likely to have delays in gastric motility, gastric emptying and intestinal transit than comparator groups although results were not uniform across all studies. Published reports suggest that complications can occur at any segment of the GI tract. These issues may derive as a consequence of severe malnourishment, from eating disorder related symptoms such as self-induced purging or from the refeeding process itself. Multiple studies noted that patients with AN report high rates of GI symptoms although in the few cases where medical testing was undertaken, correlations between self-reported symptoms and measurable pathology were not demonstrated. DISCUSSION GI complications may occur throughout the entire GI tract in patients with AN. It is recommended that clinicians use careful judgment when pursuing targeted investigation or introducing symptom specific treatments in response to GI complaints. Evidence suggests that most GI complications resolve with refeeding and cessation of ED symptoms.
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Affiliation(s)
- Mark L Norris
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Megan E Harrison
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Leanna Isserlin
- Department of Psychiatry, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Amy Robinson
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Stephen Feder
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Margaret Sampson
- Library and Media Services, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Kim AY, Jung SY, Eun LY. Life-threatening acute gastric dilatation with aorta compression in a 3-year-old child. Pediatr Int 2015; 57:1184-6. [PMID: 26387581 DOI: 10.1111/ped.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 04/10/2015] [Accepted: 04/16/2015] [Indexed: 11/30/2022]
Abstract
We report a fatal case of acute gastric dilatation in a 3-year old boy who presented with severe abdominal pain and massive gastric distension in the emergency room. On physical examination the patient was in shock due to acute abdomen and lower limb ischemia. Initial laboratory findings showed multi-organ failure with acute renal failure and pancreatitis. Abdominal computed tomography (CT) showed marked dilatation of the stomach resulting in compression of the abdominal aorta. The left kidney, spleen and pancreas were not visible on CT due to the necrotic changes. The patient was quickly stabilized by initial volume resuscitation, but suddenly deteriorated immediately after gastric decompression via nasogastric tube, and died from multi-organ failure 3 h after initial presentation.
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Affiliation(s)
- Ah Young Kim
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Se Yong Jung
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
| | - Lucy Youngmin Eun
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
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Youm SM, Kim JY, Lee JR. Acute gastric dilatation causing fatal outcome in a young female with eating disorder: a case report. Korean J Anesthesiol 2015; 68:188-92. [PMID: 25844140 PMCID: PMC4384409 DOI: 10.4097/kjae.2015.68.2.188] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 07/08/2014] [Accepted: 07/29/2014] [Indexed: 12/19/2022] Open
Abstract
A 21-year-old female with a history of bulimia nervosa came to the emergency room due to severe abdominal pain after excessive eating five hours previously. On arrival at the emergency room, extreme abdominal distension was detected and the patient's legs changed color. Computed tomography suggested severe gastric dilatation, so abdominal compartment syndrome was suspected and an emergent laparotomy was supposed to be conducted. Though anesthesia was induced without event, abrupt hemodynamic collapse developed just after the operation started. In spite of active resuscitation for 29 min, the patient did not recover and expired. As the incidence of eating disorders is increasing, anesthesiologists should keep in mind the possibility of abdominal compartment syndrome in patients with a recent history of binge eating, and prepare optimal anesthetic and resuscitation remedies against sudden deteriorations of a patient's condition.
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Affiliation(s)
- Seung-Mok Youm
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Young Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jeong Rim Lee
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Korea. ; Anesthesia and Pain Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Touré AO, Thiam O, Cisée M, Nduwimana D, Gueye ML, Seck M, Ka O, Dieng M, Touré CT. [Acute dilatation of the stomach: about 02 cases and literature review]. Pan Afr Med J 2015; 22:210. [PMID: 26955401 PMCID: PMC4760724 DOI: 10.11604/pamj.2015.22.210.8092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 10/16/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Alpha Oumar Touré
- Service de Chirurgie Générale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Ousmane Thiam
- Service de Chirurgie Générale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Mamadou Cisée
- Service de Chirurgie Générale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Diomede Nduwimana
- Service de Chirurgie Générale, CHU Aristide Le Dantec, Dakar, Sénégal
| | | | - Mamadou Seck
- Service de Chirurgie Générale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Ousmane Ka
- Service de Chirurgie Générale, CHU Aristide Le Dantec, Dakar, Sénégal
| | - Madieng Dieng
- Service de Chirurgie Générale, CHU Aristide Le Dantec, Dakar, Sénégal
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Letale Magenruptur eines 5-jährigen Mädchens mit Rett-Syndrom. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-014-0944-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Acute Gastric Dilatation Causing Acute Limb Ischemia in an Anorexia Nervosa Patient. J Emerg Med 2014; 46:e141-3. [DOI: 10.1016/j.jemermed.2013.11.093] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Revised: 10/10/2013] [Accepted: 11/17/2013] [Indexed: 11/19/2022]
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Sato H, Tanaka T. Acute gastric dilatation due to a superior mesenteric artery syndrome: an autopsy case. BMC Gastroenterol 2014; 14:37. [PMID: 24555911 PMCID: PMC3946598 DOI: 10.1186/1471-230x-14-37] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 02/14/2014] [Indexed: 01/11/2023] Open
Abstract
Background Superior mesenteric artery (SMA) syndrome occurs when the third portion of duodenum becomes tightly compressed between the SMA and the abdominal aorta (AA). Several causes of the SMA syndrome have been postulated such as marked weight loss, external compression of the abdomen, anatomic variation, and surgical alterations of anatomy. This is an autopsy case of a subject with atypical duodenal obstruction related SMA syndrome. Case presentation A 71-year-old woman died one and a half days after eating a large meal of roast meat and vegetables and experiencing subsequent nausea and abdominal pain. At autopsy, fatal acute gastric dilatation was confirmed. The posterior parietal peritoneum around the duodenum was scarred and pulled the root of the mesentery involving the SMA. The complex compressed and narrowed the third portion of the duodenum. The root of the mesentery was also thickened and had adhered to the surface of the duodenum, which may have been due to past peritonitis and disturbance of duodenal motility. Aggregation of an excessively large food mass obstructed the lumen of the duodenum. The cause of death was diagnosed as SMA syndrome with intra-duodenal aggregation of an excessively large mass of food in the narrowed duodenal lumen. Conclusion This is an atypical fatal case of acute gastric dilatation, through an excessively large mass of food obstruction at the latent narrowed duodenum.
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Affiliation(s)
- Hiroaki Sato
- Department of Forensic Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Iseigaoka1-1, Yahata-Nishi, Kitakyushu 807-8555, Japan.
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Plötzlicher Tod bei massiver Magendilatation. Rechtsmedizin (Berl) 2012. [DOI: 10.1007/s00194-012-0844-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
Eating disorders are usually associated with an increased risk of premature death with a wide range of rates and causes of mortality. “Sudden death” has been defined as the abrupt and unexpected occurrence of fatality for which no satisfactory explanation of the cause can be ascertained. In many cases of sudden death, autopsies do not clarify the main cause. Cardiovascular complications are usually involved in these deaths. The purpose of this review was to report an update of the existing literature data on the main findings with respect to sudden death in eating disorders by means of a search conducted in PubMed. The most relevant conclusion of this review seems to be that the main causes of sudden death in eating disorders are those related to cardiovascular complications. The predictive value of the increased QT interval dispersion as a marker of sudden acute ventricular arrhythmia and death has been demonstrated. Eating disorder patients with severe cardiovascular symptoms should be hospitalized. In general, with respect to sudden death in eating disorders, some findings (eg, long-term eating disorders, chronic hypokalemia, chronically low plasma albumin, and QT intervals >600 milliseconds) must be taken into account, and it must be highlighted that during refeeding, the adverse effects of hypophosphatemia include cardiac failure. Monitoring vital signs and performing electrocardiograms and serial measurements of plasma potassium are relevant during the treatment of eating disorder patients.
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Häusler I, Augschöll C, Rabl C, Öfner-Velano D, Emmanuel K. Life-threatening gastric dilatation with anorexia nervosa. Eur Surg 2011. [DOI: 10.1007/s10353-011-0616-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Tweed-Kent AM, Fagenholz PJ, Alam HB. Acute gastric dilatation in a patient with anorexia nervosa binge/purge subtype. J Emerg Trauma Shock 2011; 3:403-5. [PMID: 21063567 PMCID: PMC2966577 DOI: 10.4103/0974-2700.70774] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2009] [Accepted: 07/19/2010] [Indexed: 01/28/2023] Open
Abstract
Acute gastric dilatation is a rare complication of anorexia nervosa binge/purge subtype that results from gastrointestinal abnormalities, including decreased gastric motility and delayed gastric emptying. Early diagnosis and intervention is critical since delay may result in gastric necrosis, perforation, shock, and death. We report a 26-year-old female with anorexia nervosa binge/purge subtype, who presented with abdominal pain and nausea after a binge episode. Abdominal radiography and computed tomography showed a grossly dilated stomach measuring 32 cm × 17.9 cm consistent with acute gastric dilatation. She underwent exploratory laparotomy with gastrotomy and gastric decompression, and recovered uneventfully. Initially, the patient denied the binge episode, as many patients with eating disorders do, but later revealed an extensive history of anorexia nervosa binge/purge subtype. This case stresses the importance of obtaining a thorough history of eating disorders and maintaining a high index of suspicion for acute gastric dilatation in young women who present with abdominal pain and distention.
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Affiliation(s)
- Ailis M Tweed-Kent
- Division of Trauma, Emergency Surgery, and Critical Care, Department of Surgery, Massachusetts General Hospital, 55 Fruit St., Boston, MA, USA
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García Salido A, Martínez de Azagra A, de la Torre Espí M, Pérez Suárez E, López Neyra A, Cañedo Villarroya E. [Acute gastric dilation due to food gorging: Could be a life-threatening emergency]. An Pediatr (Barc) 2010; 73:148-9. [PMID: 20605118 DOI: 10.1016/j.anpedi.2010.05.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Revised: 05/19/2010] [Accepted: 05/20/2010] [Indexed: 02/08/2023] Open
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Estour B, Germain N, Diconne E, Frere D, Cottet-Emard JM, Carrot G, Lang F, Galusca B. Hormonal profile heterogeneity and short-term physical risk in restrictive anorexia nervosa. J Clin Endocrinol Metab 2010; 95:2203-10. [PMID: 20305007 DOI: 10.1210/jc.2009-2608] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
CONTEXT The relevance of hormonal assessment in anorexia nervosa (AN) management is still unclear. The short-term physical risk during undernutrition period of the disease is partially predicted by anthropometric and electrolytic parameters. OBJECTIVE The objective of the study was to evaluate hormonal profiles in a large cohort of AN and their relationship with critical states. DESIGN AND SETTING This was an observational monocentric cross-sectional study performed in the endocrinological unit. PATIENTS AND OTHER PARTICIPANTS Participants included 210 young female subjects with restrictive-type AN and 42 female controls of comparable age. MAIN OUTCOME MEASURES The following hormonal parameters were measured: thyroid hormones, GH, IGF-I, cortisol, oestradiol, FSH, LH, SHBG, dehydroepiandrosterone sulfate, plasma metanephrines, and bone markers. Their relation with registered short-term evolution of AN subjects after hormonal assessment was evaluated. RESULTS Except for metanephrines and dehydroepiandrosterone sulfate, most of the hormonal abnormalities previously reported in AN were confirmed. The manifestation of these hormonal abnormalities started below different body mass index (BMI) levels, ranging between 17 and 15 kg/m(2), even though an important percentage of normal values for every parameter was still noticed for very low BMIs. All patients who developed critical states during the 3 months after the hormonal assessment presented with BMI less than 15 kg/m(2) and a very increased level of cortisol, GH, and increased values of metanephrines. CONCLUSIONS The hormonal response to undernutrition is heterogeneous in a large population with restrictive AN. In clinical practice, metanephrines, GH, and/or cortisol data could be used as important predictors for severe short-term outcome.
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Affiliation(s)
- Bruno Estour
- Endocrinology Department, Centre Hospitalier Universitaire Saint Etienne, 42055 Saint Etienne, Cedex 2, France.
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