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Kim, Kim, and Song: A Case of Gastric Emphysema in Anorexia Nervosa Presenting as Acute Gastric Distension
Case Report
The Korean Journal of Gastroenterology

The Korean Journal of Gastroenterology 2012; 60(5): 315-319.

Published online: 22 November 2012

DOI: https://doi.org/10.4166/kjg.2012.60.5.315

A Case of Gastric Emphysema in Anorexia Nervosa Presenting as Acute Gastric Distension

Taeyun Kim, Heung Up Kim, Hyun Joo Song

Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea.

Correspondence to: Heung Up Kim, Department of Internal Medicine, Jeju National University Hospital, 15 Aran 13-gil, Jeju 690-767, Korea. Tel: +82-64-717-1363, Fax: +82-64-717-1131, kimhup@hanmail.net

Received 24 August 2011       Revised 27 September 2011       Accepted 28 September 2011

Copyright © 2012 The Korean Society of Gastroenterology

(open-access):

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gas within the gastric wall is an alarming finding and a rare condition. Clinically, this condition is divided into two entities; Gastric emphysema and emphysematous gastritis. These two diseases should be differentiated because they are characterized by different clinical symptoms, possible etiology, treatment and prognosis. While emphysematous gastritis is a severe condition with high mortality, gastric emphysema is asymptomatic and usually has benign course. Rarely, anorexia nervosa and bulimia nervosa have been discribed to be associated with acute gastric distension and duodenal obstruction induced by superior mesentery artery syndrome. So, gastric emphysema could be accompanied by acute gastric distension induced by anorexia nervosa. We report a rare case of gastric emphysema in a patient with anorexia nervosa presenting as superior mesenteric artery syndrome with relevant literatures. In this case, the gastric emphysema was improved without surgical intervention after nasogastric tube for decompression and feeding insertion in the fourth portion of the duodenum.

Keywords: Emphysema, Emphysematous gastritis, Anorexia nervosa, Superior mesenteric artery syndrome, Gastric dilatation

Figures and Tables

Fig. 1
(A) Severe gastric gaseous distention was noted on plain abdominal radiograph. (B) Consequently, abdominal left hemidiaphragmatic elevation was visualized on plain chest radiograph.
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Fig. 2
Contrast media enhanced abdominal computed tomography. (A) Multiple air (white arrows) densities were seen in the distended gastric wall. (B) Coronal image showed multiple air (white arrow) densities in the gastri wall. The second portion of the duodenum was dilated (white blank arrow). (C) Severe narrowing the space (white arrow head) between the aorta and superior mesenteric artery and markedly dilated second portion (white blank arrow) were also seen. Nasogastric tube was inserted to decompress the distended stomach.
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Fig. 3
Upper gastrointestinal series. The contrast material-filled duodenal lumen (white arrow) showed abrupt vertical cut-off (white blank arrow) in front of the lumbar vertebrae due to superior mesenteric artery syndrome.
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Fig. 4
Upper gastrointestinal series on the hospital 27 days after nasogastric tube removal showed no delayed passage of barium on the third portion of the duodenum.
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Notes

Financial support: None.

Conflict of interest: None.

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