Clinical communication: Adults
Acute Tension Pneumothorax and Tension Pneumoperitoneum in a Patient with Anorexia Nervosa

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Abstract

Gastric rupture secondary to bulimia is a rare complication of anorexia nervosa first described in 1968. We present a case of an 18-year-old woman who presented to the Emergency Department with acute gastric rupture leading to both tension pneumoperitoneum and tension pneumothorax. Although case reports of spontaneous pneumoperitoneum and separate reports of spontaneous pneumothorax in anorexic patients have been published, none of them has been associated with gastric rupture.

Introduction

Anorexia nervosa is a pathological phobia of obesity. The Diagnostic and Statistical Manual of Mental Disorders, 4th edition defines this condition by four criteria: a refusal to maintain body weight for age and height, a fear of gaining weight despite being underweight, an abnormal body image, and (in women) amenorrhea. Gastric rupture secondary to bulimia is a rare complication of anorexia nervosa first described in 1968 (1). Anorexic patients carry a 20% risk of chronic disability and a 0.5% risk of death as related to either inanition or suicide (2). This case highlights the typical features of anorexia as well as an example of a life-threatening complication that can occur in this population.

Section snippets

Case Report

An 18-year-old woman, an actress and dancer from Connecticut, was referred to the Emergency Department (ED) by her primary physician for abdominal pain, nausea, vomiting, and dehydration. She reported being in her usual state of good health until 2 days before admission, when she began having intermittent episodes of nausea and vomiting. These symptoms continued up until the night before presentation, when she ingested a large vegetablee-protein drink. Soon thereafter, she began experiencing

Discussion

Anorexia nervosa is a serious eating disorder affecting about 1% of the young female population. It is associated with high morbidity and mortality between 5% and 20% (3). Among the patients diagnosed with anorexia nervosa, 47% are also noted to have binging episodes of large amounts of food, which can predispose to gastric dilatation and rupture (4).

Only a handful of cases have reported pneumomediastinum or pneumothorax in association with anorexia nervosa (5). The postulated mechanism for

Summary

Exhaustion from lack of nourishment is the sine qua non in this population and the complications thereof are the leading cause of mortality (54%) (10). The subsets of cases provided here demonstrate that the destructive pattern of binging in emaciated patients can predispose to a rapid and possibly fatal deterioration. The cohort of patients described previously had a mortality rate of 25% in their initial hospital presentation alone. Although death due to gastric rupture represents a small

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