Images in Clinical Medicine

Severe Abdominal Pain in a Girl

Carrie A. Czarnecki, M.D., and D. Fergus O'Coclain, M.D.

N Engl J Med 2002; 347:e3September 5, 2002

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Figure 1 A 17-year-old girl with a history of bulimia and binge eating presented to the emergency room with severe, diffuse abdominal pain six hours after ingesting massive amounts of food and drink. She had been unable to induce vomiting at home.

Physical examination revealed a markedly distended abdomen that was firm and tender to palpation, with absent bowel sounds. Computed tomography of the abdomen and pelvis with contrast medium showed massive gastric distention, with fluid and food causing a considerable mass effect on adjacent organs, resulting in partial gastric obstruction without perforation. Gastric lavage yielded 11 liters of partially digested particulate material, with resulting decompression of the stomach and alleviation of symptoms. She was subsequently transferred to the psychiatry inpatient service.

Carrie A. Czarnecki, M.D.
D. Fergus O'Coclain, M.D.
Mayo Clinic and Foundation, Rochester, MN 55905