American Journal of Emergency Medicine 35 (2017) 1210.e5–1210.

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American Journal of Emergency Medicine

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Case Report

Obstructive acute renal failure by severe gastric distension after binge

Julie Dumouchel, MD, Dr a,⁎, Virginie Lvovschi, MD, Dr b, Luc-Marie Joly, PHD, Dr b
a
CHU Charles Nicolle Rouen, 45 rue de la Tour d'Auvergne, 3700 Tours, France
b
CHU Charles Nicolle Rouen, France

a r t i c l e i n f o a b s t r a c t

Article history: Binge eating occurs in patients with eating disorders and can result in metabolic complications, leading to gastric
Received 14 March 2017 rupture or necrosis. However, organ failure as acute renal failure is rarely observed. We report the case of an over­
Accepted 19 March 2017 eating episode resulting in massive gastric dilatation and acute renal failure with abdominal pressure and bilat­
eral ureteral obstruction. The outcome was favorable with gastric aspiration and fasting.
Keywords:
© 2017 Elsevier Inc. All rights reserved.
Binge
Obstructive renal failure
Eating disorder
Gastric distention
Abdominal compartment syndrome

1. Introduction
A binge episode is a massive intake of food and beverage. It is mainly
observed in bulimic patients. Although complications following binge
are rare, we should be aware of severe outcomes as gastric distension
or necrosis [1]. We report herein an original case of a binge episode
complicated by acute renal failure (Figs. 1 and 2).
2. Observation
Our 26-year old female patient had a 4-year history of anorexia
nervosa. BMI was 14.06.
She presented to the Emergency Room (ER) of our tertiary care cen­
ter after a 1-h binge, but was unable to specify the amounts ingested. To
purge, she drank an extra 1.5 L of water. Vital signs were normal. Clinical
examination revealed diffuse abdominal pain, which was relieved after
intravenous hydration, metoclopramide and analgesics: paracetamol
and Spasfon®. The patient then returned home.
The following day, her family physician referred her back to ER for
suspicion of distended bladder due to anuria with painful abdominal
mass.
On arrival, our patient had intense diffuse abdominal pain, absence
of gas and stool since the previous day and total food intolerance. On
clinical examination, heart rate was 135 bpm and temperature was
Abbreviations: BPM, Beats Per Minute; ER, Emergency Room; BMI, Body Mass Index;
CT, Computed Tomography; MDRD, Modification of Diet in Renal Disease.
⁎ Corresponding author.
E-mail addresses: J.DUMOUCHEL@chu-tours.fr (J. Dumouchel),
Virginie.lvovschi@chu-rouen.fr (V. Lvovschi), Luc-marie.joly@chu-rouen.fr (L.-M. Joly).
37.8 °C. Her abdomen was distended with an extensive mass from the
pelvis to the ribs.
Biology highlighted acute renal failure with a creatinine clearance of
40 mL/min (MDRD), hypernatremia of 156 mmol/L and 110 hyper­
chloremia mmmol/L. The bladder was empty on bedside bladder ultra­
sound imaging.
A suspected intestinal obstruction was confirmed by Computed To­
mography (CT) imaging showing major gastric distension. Our patient's
stomach measured 35 × 20 × 13.5 cm, with an estimated volume of 6 L
occupying the whole abdominal cavity and displacing and compressing
the other organs, which were practically absent from view. There were
no signs of pneumoperitoneum or gastric rupture. The absence of con­
trast material limited visualization of an organic pain zone of vascular
or compressive origin.
Treatment included total fasting and nasogastric aspiration of 1.2 L
in 30 min and an intravenous rehydration saline solution of 1.5 L over
a period of 12 h. On day 2, the outcome was favorable after removal of
part of the obstacle with diuresis and subsequent recovery of digestive
transit. In addition, laboratory values returned to normal; creatinine
clearance of 105 mL/min, serum sodium 136 mmol/L and serum chlo­
ride to 100 mmol/L. Our patient was transferred to Gastro-Enterology
Unit then home at day 3 with close follow-up.
3. Discussion
Eating disorders are increasingly frequent pathologies with varying
and intertwined forms and concern almost 10% of the general popula­
tion [2,3].
Overeating affects 1.5 to 2% of the general population with or with­
out a context of bulimia. It is characterized by brutal and massive inges­
tion of food (in b2 h), without any sensation of hunger. Food intake is

http://dx.doi.org/10.1016/j.ajem.2017.03.077
0735-6757/© 2017 Elsevier Inc. All rights reserved.
1210.e6 J. Dumouchel et al. / American Journal of Emergency Medicine 35 (2017) 1210.e5–1210.e7
Fig. 1. Images of Abdominal Computed Tomography without enhancement showing severe gastric distension. Stomach volume occupying the whole abdominal cavity. 1A: sagittal view 1
B: frontal view. 1 C: coronal view.
continued until a feeling of uncomfortable abdominal fullness appears.
It differs from simple bulimia episodes by the absence of compensatory
behaviors as vomiting, taking laxatives or intense physical exercise.
Complicated gastric distension should be suspected in the presence
of severe abdominal pain and distension following a major food episode.
Young age should not reassure as signs of shock are often delayed due to
adaptability which masks the severity. Several deaths [4] or late sequel­
ae have been reported; including gastrectomy and repeated gastroin­
testinal surgery. Abdominal CT is generally performed to identify signs
of rupture or necrosis. Contrast injection is desirable to highlight vascu­
larization disorders but may exacerbate acute renal failure.
Fig. 2. Image of Abdominal Computed Tomography without enhancement showing
abdominal compartment syndrome. Compressed kidneys resulting in obstructive acute
renal failure.
We describe here the case of a patient presenting acute obstructive
anuric renal failure following binge, which has not been described pre­
viously. We suspected direct compression of the ureters and shutdown
of glomerular filtration related to intra-abdominal pressure.
Several complications related to gastric distension have been report­
ed as case studies:
- Gastric rupture [4,5]
- Infarction or complete gastric necrosis [6-9]
- Sympathetic and parasympathetic neurological compression which
may be responsible for heart rhythm disorders [4]
- Aortic occlusion with mesenteric ischemia syndrome secondary to
compression [10-12]
- Abdominal compartment syndrome after major gastric dilatation
with vascular compression but no renal impairment [13].
However, eating disorders are not the only context for complicated
distensions. Gomez and al reported a case of gastric necrosis, in absence
of any psychiatric disease, after a copious family meal that required sur­
gery with total gastrectomy [9]. The level of complication does not seem
to be related to the amount of food present in the stomach, but rather to
organ failure [4,10].
Previous published cases have mainly required abdominal and gas­
tric decompression surgery by laparotomy and/or total gastrectomy
[14], sometimes leading to disabling outcomes.
4. Conclusion
We present an original case of obstructive acute renal failure follow­
ing a binge episode. Although complications following binge are rare,
the presence of massive gastric distension and persistent abdominal
pain associated with biological alterations should alert emergency phy­
sicians to a diagnosis of obstructive acute renal failure. Early treatment
should be initiated with gastric aspiration to reduce late sequelae.
 J. Dumouchel et al. / American Journal of Emergency Medicine 35 (2017) 1210.e5–1210.e7 1210.e7

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[7] Turan, et al. Gastric necrosis and perforation caused by acute gastric dilatation: re­
The authors are grateful to Nikki Sabourin-Gibbs, Rouen University port of a case. Surg Today April 2003;33(4):302–4.
Hospital, for her help in editing the manuscript, and to Malaika Lasfar, [8] Lunca, et al. Acute Massive Gastric Dilatation: Severe Ischemia and Gastric Necrosis
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[10] Gyurkovics, et al. Fatal outcome from extreme acute gastric dilation after an eating
binge. Int J Eat Disord November 2006;39(7):602–5.
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