it is characterized by acute and mostly intense abdominal pain accompanied by peritonism and potentially meteorism , nausea , vomiting and in severe and advanced cases shock . in most cases
abdominal pathologies cause this acute condition including  but not limited to  appendicitis , cholecystitis , pancreatitis , mesenteric ischemia , ileus and perforations of hollow organs , . however ,
also extra - abdominal diseases can present with symptoms of an acute abdomen such as testicular torsion , myocardial infarction or diabetic ketoacidosis . due to
the fact that an acute abdomen is always potentially life - threatening , prompt action is required to obtain the diagnosis and to immediately initiate adequate therapy .
diagnostically , in addition to clinical examination and analysis of serum parameters , imaging such as sonography , computed tomography ( ct ) and magnetic resonance imaging ( mri ) are foremost in leading to the correct diagnosis .
however , as mentioned above , the causes for acute abdominal symptoms are versatile and at times are found in medical areas other than gastroenterology itself . in this study
we report on an interesting and unique case in which a psychiatric condition was the underlying disease leading to an acute abdominal picture which required immediate surgical intervention .
a 28-year - old woman presented in our surgical emergency unit with a sudden onset of progressive abdominal discomfort and pain .
routine laboratory analysis did not show any pathologies , including normal hemoglobin , leucocytes , c - reactive protein ( crp ) as well as serum electrolytes . because of the acute and dramatic clinical presentation we immediately performed a computed tomography of the abdomen .
this revealed a massively distended stomach with a cranio - caudal extension of 35 cm reaching the lesser pelvis , however , without evidence for perforation ( figure 1 ( fig .
a stomach tube was placed , which , however , did not drain any significant amount of stomach content .
we performed a gastrotomy of the gastric antrum and recovered ( over the period of one hour ) a large amount of cementitiously clotted and undigested food scraps from the stomach .
the stomach tube as well as the intrabdominal drainage could be removed within the first days after surgery .
a gradual reintroduction of liquids was well tolerated . on the sixth postoperative day we performed a radiological imaging of the stomach using contrast medium which revealed a re - tonised stomach of a normal size without evidence for any stenosis ( figure 2 ( fig .
subsequently , the patient was allowed to normal food intake , which was well tolerated as well .
the postoperatively initiated evaluation of the patient by a psychiatrist revealed that she had been suffering from an eating disorder since her childhood .
temporarily , her body mass index ( bmi ) had dropped to 11 kg / m . at consultation in our clinic
however , the patient reported on daily binge eatings caused by conflicts at her workplace .
this had also occurred on the day of hospital admission , however on this day , the routinely self - induced vomiting after the binge attack failed . in a good status of health
here , we report on an unusual case in which a binge attack in a young woman suffering from an eating disorder caused a massive dilatation of her stomach .
this dilation was not reversible either by self - induced vomiting or by drainage using a stomach tube .
some other authors have reported on cases in which eating disorders such as anorexia nervosa or bulimia nervosa lead to acute gastric dilatation , , , . in line with the higher incidence of eating disorder in young females , mostly women in the age between 14 and 30 years were affected . in some cases , the so - called superior mesenteric artery syndrome has been suggested to cause or at least promote gastric dilatation in patients with eating disorders , . for this syndrome
it has been proposed that malnutrition leads to the shrinkage of a fad pad localized between the aorta and outlet of the superior mesenteric artery .
this , in turn , may cause compression of the duodenum thereby promoting gastric dilatation , in particular in cases when eating binges occur . in the reported case of this study ,
immediate imaging revealed the diagnosis and emergency explorative laparotomy and gastrotomy allowed for full recovery of the patient without complications or any residuals .
this prompt and direct action including emergency laparotomy appears to be justified and essential , given the fact that some authors have reported severe complications such as gastric perforation and/or necrosis in patients with similar conditions , .
furthermore , in some cases extended surgical approaches such as partial gastrectomy or even gastric resection were required .
the fact that some patients did not recover and , unfortunately , passed away , confirms the severity of this condition as well as the importance of adequate diagnosis and immediate ( surgical ) therapy .
 the clinical picture of an acute abdomen is frequently encountered in emergency medicine . in most cases 
 abdominal pathologies underlie this condition , however , also extra - abdominal diseases may present or cause an acute abdomen . the fact that this condition is potentially life - threatening highlights the importance of instant action . here 
 , we report on the case of a young woman that presented with an acute abdomen in our clinic . 
 imaging revealed a massively distended stomach reaching the lesser pelvis . 
 initially , the etiology for the gastric dilatation remained unsolved . on the same day we performed an explorative laparotomy 
 in which massive amounts of clotted , undigested food was recovered via a gastrotomy . 
 postoperatively , upon psychiatric consultation , an eating disorder with daily eating binges could be revealed as being the cause for the acute and dramatic gastric dilatation . 
 the patient fully recovered from surgery and psychiatric co - treatment was initiated . 
 this unique case report demonstrates how a psychiatric condition may lead to an acute abdomen , however , it also emphasizes the importance of prompt diagnosis and adequate therapy to avoid complications and allowing for full recovery . 
Introduction
Case description
Discussion
Notes
Competing interests