title: Acute gastric dilatation causing acute limb ischemia in an anorexia nervosa patient.
abstract: BACKGROUND
  Acute gastric dilatation is a rare but severe complication of anorexia nervosa. Gastric dilatation causing abdominal compartment syndrome with lower-limb ischemia is even less common. This case report illustrates the importance of a holistic clinical approach of every patient presenting to the emergency department (ED), even when the reason for admittance is organ specific.
  
  
  METHODS
  We report the case of a young female patient presenting to the ED with a painful white left leg. Clinical examination revealed acute lower-limb ischemia, abdominal distention, and shock. Diagnostic work-up, including an abdominal computed tomography scan, showed compression of the aorta, inferior vena cava, and both iliac arteries, as well as hypoperfusion of the right kidney and left liver lobe, all due to compression by a massive gastric dilatation. Gastroscopy revealed a massively dilated stomach containing > 6 L of fluid and gastric wall ischemia. After decompression, the circulation to the lower limbs recovered immediately. The day after admission the patient developed an acute abdomen leading to a semi-urgent laparoscopy during which a sleeve gastrectomy was performed for the treatment of partial gastric necrosis. Clinical evolution afterward was favorable and the patient recovered completely.
  
  
  CONCLUSIONS
  This case report underscores the importance of a thorough clinical examination in every patient admitted to the ED. Early diagnosis and treatment are mandatory in preventing fatal complications.
authors.affiliation: Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium; Research Group on Emergency and Disaster Medicine Brussels (ReGEDiM Brussels), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Ellen
authors.initials: E
authors.lastname: Van Eetvelde
authors.affiliation: Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium; Research Group on Emergency and Disaster Medicine Brussels (ReGEDiM Brussels), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Lies
authors.initials: L
authors.lastname: Verfaillie
authors.affiliation: Department of Gastrointestinal Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium.
authors.forename: Nele
authors.initials: N
authors.lastname: Van De Winkel
authors.affiliation: Department of Emergency Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium; Research Group on Emergency and Disaster Medicine Brussels (ReGEDiM Brussels), Vrije Universiteit Brussel, Brussels, Belgium.
authors.forename: Ives
authors.initials: I
authors.lastname: Hubloue
mesh_terms: D000006:Abdomen, Acute / Q000209:etiology*; D000208:Acute Disease; D000856:Anorexia Nervosa / Q000150:complications*; D042241:Early Diagnosis; D005260:Female; D013271:Gastric Dilatation / Q000150:complications*; D006801:Humans; D007511:Ischemia / Q000209:etiology*; D007866:Leg / Q000098:blood supply*; D055815:Young Adult
keywords: abdominal compartment syndrome; anorexia nervosa; gastric dilatation