A succussion splash-on was heard on auscultation. On examination in the emergency department, she was obviously distressed and had a tense distended abdomen, which was tympanic to percussion. A gastroscopy performed 2 months prior was normal. She had no past history of abdominal surgery, diabetes or peptic ulcer disease. Her past medical history included incidentally detected gallstones, trigeminal neuralgia, anxiety and hypertension. The GP provided counselling and prescriptions for a benzodiazepine (for episodes of acute distress) and omeprazole (for the epigastric pain). Over the preceding months she had presented several times to her general practitioner complaining of epigastric pain, anxiety and weight loss. She described significant emotional distress since the sudden death of her eldest son 6 months previously. A woman, 82 years of age, presented to the emergency department with an 8 day history of worsening generalised abdominal pain, nonfaecal emesis and abdominal distension associated with a background history of 20 kg weight loss over the past few months. Many patients are reluctant to disclose their condition, so radiological findings have a central role in identifying undiagnosed eating disorders. Recognition of such complications is critical to effective patient care, and requires a radiologist to be aware of the spectrum of imaging abnormalities that may be seen. The patient underwent a complete detailed psychiatric evaluation for conclusive diagnostic definition. The early stage of the eating disorder or an oral “obsessive” care may have been the explanation of the absence of these pathognomonic aspects. Furthermore, a repeated careful examination did not reveal any dental changes: there was no erosion of tooth enamel, nor small hemorrhages of palate, nor gland salivary swelling. Afterward, despite a thorough medical history assessment regarding, in particular the nutritional aspect, the patient continued to deny previous eating disorders nor was there any other helpful information reported by the parents in this regard. Even in the context of normal body weight and no previously known eating disorder, the massive gastric distension following a “reported” single eating binge associated with subsequent delayed gastric emptying, raised the high probability of a severe eating disorder, probably bulimia, at the first clinical and radiological presentation. 5), and an endoscopic study showed no pathological signs in the esophageal and gastric mucosa. Subsequently, after 3 days, he underwent radiography with contrast medium that showed delayed gastric emptying (Fig. A nasogastric tube was placed, and a large amount of gastric contents consisting of partially digested particulate material were evacuated during 3 days (10 l) with partial relief of symptoms. Computed tomography of abdomen and pelvis showed massive gastric distension with a considerable mass effect on adjacent organs by fluid and food resulting in gastric obstruction without perforation (Figs. ![]() An abdominal plain film showed a large gastric bubble and a paucity of small bowel gas without evidence of free abdominal air (Fig. Laboratory examinations showed a mild leukocytosis, amylase: 90 U/L, and in the normal range: electrolytes, acid–base, and iron profile, and the hemoglobin value. Temperature was 37 ☌, heart rate: 95 beats per minute, blood pressure 105/75 mmHg, respiratory rate 32 breaths per minute, and body mass index was 22. The remainder of the physical examination was unremarkable. There was no rebound, and no masses were palpable. Physical examination revealed a markedly distended abdomen, and epigastric tenderness with absent bowel sounds. He reported that he was in his usual state of health until the heavy food intake. He had been unable to induce vomiting to reach relief at home. He reported a binge eating several hours before the onset of symptoms. A 23-year-old man with no past medical history presented to the emergency department(ED) with severe, diffuse abdominal pain, and nausea.
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