Acute superior mesenteric artery syndrome and pancreatitis in anorexia nervosa

Eating Disorders Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia.
Australasian Psychiatry (Impact Factor: 0.47). 10/2010; 18(6):523-6. DOI: 10.3109/10398562.2010.498885
Source: PubMed


The aim of this paper is to describe the presentation and clinical management of a patient with anorexia nervosa complicated by superior mesenteric artery syndrome and pancreatitis, and discuss the association between these conditions.
We present a case report and briefly review the relevant literature.
A 17-year-old girl with undiagnosed anorexia nervosa presented acutely with abdominal symptoms and vomiting. After numerous investigations, she was diagnosed with the rare condition of superior mesenteric artery syndrome and pancreatitis, leading to a prolonged hospital admission and management on both an acute medical/surgical ward and an eating disorders unit.
Anorexia nervosa has been associated with superior mesenteric artery syndrome and pancreatitis. Clinical awareness of these conditions can result in prompt diagnosis and optimal management of these patients.

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    • "Gastrointestinal complications in eating disorders are common and include parotid enlargement with hyperamylasemia , dysphagia, gastric dilatation due to delayed gastric emptying, constipation, pancreatic abnormalities [1] and superior mesenteric artery syndrome (SMAS) [3]. However, only two patients who simultaneously suffered from both SMAS and pancreatitis have ever been reported in eating disorders [4] [5]. We describe here a patient with ED-NOS who exhibited both SMAS and pancreatitis concomitantly, the first case report of a patient with these diseases in the pediatric literature. "
    Open Journal of Pediatrics 01/2011; 1(04):94-97. DOI:10.4236/ojped.2011.14022
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    ABSTRACT: Background/Aim: The role of diet as the cause of acute pancreatitis (AP) has been suggested. The aim of the current review was to determine if there exists sufficient evidence linking nutrition, or the lack of it, to the pathogenesis of AP. Patients and Methods: A systematic search of the scientific literature was carried out using Embase, PubMed, MEDLINE, and the Cochrane Central Register of Controlled Trials for the years 1965 - 2011 to obtain access to studies involving dietary factors and the pathogenesis of AP. Results: A total of 17 studies were identified describing diet and AP. These included 12 human and 5 animal studies. 8 reports were found to link malnutrition and/or refeeding to the pathogenesis of AP. Two studies found an increased consumption of fats and proteins in patients with alcohol-related AP while 1 study noted a lesser intake of carbohydrate in patients. However, none of these differences attained statistical significance. A recent prospective case-control study found a significantly higher risk for AP amongst patients eating par-boiled rice and fresh water fish. Conclusions: Evidence from literature does not appear to support the role of diet as a single bolus meal as a cause for AP. Prolonged consumption of diets rich in proteins and fats may work synergistically with gallstones / alcohol to trigger an attack of AP indicating a possible role of diet as a cofactor in the development of AP possibly by lowering the threshold needed by these other agents to lead to the attack of AP.
    Saudi Journal of Gastroenterology 03/2012; 18(5):310. DOI:10.4103/1319-3767.101124 · 1.12 Impact Factor
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    ABSTRACT: Eating disorders are a major challenge for health professionals, with many patients receiving ineffective care due to underdiagnosis or poor compliance with treatment. The incidence of eating disorders is increasing worldwide, producing an increasing burden on healthcare systems, and they most often affect young patients, with significant long-term complications. The effects of long-term malnutrition manifest in almost every organ system, and many can be detected radiologically, even without overt clinical findings. Musculoskeletal complications including osteoporosis result in a high incidence of insufficiency fractures, with long-term implications for bone health and growth, while respiratory complications are often recognized late due to disordered physiologic responses to infection. Gastrointestinal complications are numerous and in extreme cases may result in fatal outcomes after acute gastric dilatation and rupture subsequent to binge eating. In patients with severely disordered eating, in particular anorexia nervosa, marked derangement of electrolyte levels may result in refeeding syndrome, which requires emergent management. Recognition of such complications is critical to effective patient care and requires radiologists to be aware of the spectrum of imaging abnormalities that may be seen. Since many patients are reluctant to disclose their underlying condition, radiologists also play a critical role in identifying previously undiagnosed eating disorders. ©RSNA, 2013.
    Radiographics 07/2013; 33(4):1171-1193. DOI:10.1148/rg.334125160 · 2.60 Impact Factor
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