Massive gastric dilation and necrosis in anorexia nervosa: cause or effect?

A 26-year-old female with a diagnosis of anorexia nervosa was admitted and found to have massive gastric dilation and gastric necrosis. Imaging studies suggested the possibility of superior mesenteric artery (SMA) syndrome. She was successfully managed with prompt gastric decompression and was able to resume oral nutrition. Gastric dilation and necrosis may be seen in anorexia nervosa as either an independent event or an SMA syndrome. The SMA syndrome may also be present as either an incidental finding or a true pathophysiologic entity. Finally, significant foregut dysfunction may be mistaken for an eating disorder. Although there is clearly an association between gastric dilation, the SMA syndrome, and eating disorders, cause and consequence may not always be straightforward. Prompt recognition and conservative management are advocated in the absence of abdominal catastrophe.