Journal des troubles alimentaires et nutritionnels

Superior Mesenteric Artery Syndrome with: Gastric Emphysema, Gas in the Portal Vein and Pneumoperitoneum Due to Anorexia Nervosa

Klaudia Korecka, Grzegorz Kudela, Magdalena Lucyga, Małgorzata Janas-Kozik, Ireneusz Jelonek, Agnieszka Pastuszka and Tomasz Koszutski

12- year- old patient suffering from anorexia nervosa feeding implementation after a period of prolonged fasting cause a refeeding syndrome, which manifests itself as acute electrolytes deficiency resulting in dysfunction of the entire organism, including bowel transit time disorders. Gastric antral electrical dysarhythmias which develop in this mechanism promote dilatation of the stomach. Concomitant compression and obstruction of the third portion of the duodenum due to superior mesenteric artery syndrome (Superior Mesenteric Artery syndrome) results in stomach dilatation, which can lead to gastric emphysema and pneumoperitoneum. The pathomechanisms described above create a vicious circle mechanism general symptom in the young patient.Gastric emphysema with gas in the portal vein and Superior mesenteric artery syndrome are potentially threatening complications of chronic malnutrition and anorexia. Intensive conservative treatment with a control CT scan after 24 to 48 hours may be useful when making the decision to withdraw from surgical procedure. Releasing the duodenum from the compression gives the opportunity to eliminate one element of the vicous circle mechanism as far as the treatment of eating disorders is concerned.