Superior mesenteric artery syndrome and acute pancreatitis in a boy with eating disorder: a case report

Toru Watanabe, Motoi Fujita, Yutaka Hirayama, Yasushi Iinuma
DOI: 10.4236/ojped.2011.14022                

Abstract

Eating disorders are an important cause of physical and psychosocial disturbances. Gastrointestinal complications in eating disorders are common and include pancreatitis and superior mesenteric artery syndrome (SMAS). However, only two patients who simultaneously suffered from both SMAS and pancreatitis in the setting of an eating disorder have ever been reported in the literature. We describe here a patient with eating disorder not otherwise specified (ED-NOS) who exhibited both SMAS and pancreatitis concomitantly. An 11-year-old boy with ED-NOS had presented with the sudden onset of recurrent bilious vomiting, abdominal distension and abdominal pain. Laboratory and imaging studies revealed that the patient had SMAS and acute pancreatitis. Gastric decompression and intravenous infusion of fluids promptly improved his abdominal symptoms and laboratory data. This is the first case report of a patient with ED-NOS who simultaneously suffered from SMAS and pancreatitis in the pediatric literature. Since SMAS and pancreatitis can both cause patients to be severely ill, these diseases should be considered in patients with eating disorders who exhibit abdominal symptoms such as vomiting or abdominal pain.

Keywords

Eating Disorder Not Otherwise Specified; Superior Mesenteric Artery Syndrome; Pancreatitis; Gastrointestinal Complications

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	McClain, C.J., Humphries, L.L., Hill, K.K. and Nickl, N.J. (1993) Gastrointestinal and nutritional aspects of eating disorders. Journal of the American College of Nutrition, 12, 466-474.
[2]	Forman, S.F. (2010) Eating disorders: epidemiology, pathogenesis, and clinical features. UpToDate, UpToDate Inc., Waltham. http://www.uptodate.com/contents/eating-disorders-epidemiology-pathogenesis-and-clinical-features?source=search_result&selectedTitle=1%7E150
[3]	Froese, A.P., Szmuilowicz, J. and Bailey, J.D. (1978) The superior-mesenteric-artery syndrome. Cause or complication of anorexia nervosa? Canadian Psychiatric Association Journal, 23, 325-327.
[4]	Keane, F.B., Fennell, J.S. and Tomkin, G.H. (1978) Acute pancreatitis, acute gastric dilatation and duodenal ileus following refeeding in anorexia nervosa. Irish Journal of Medicine Sciences, 147, 191-192. doi:10.1007/BF02939399
[5]	Gwee, K., The, A. and Huang, C. (2010) Acute superior mesenteric artery syndrome and pancreatitis in anorexia nervosa. Australasian Psychiatry, 18, 523-526. doi:10.3109/10398562.2010.498885
[6]	Merrett, N.D., Wilson, R.B., Cosman, P. and Biankin, A.V. (2009) Superior mesenteric artery syndrome: diagnosis and treatment strategies. Journal of Gastrointestinal Surgery, 13, 287-292. doi:10.1007/s11605-008-0695-4
[7]	Biank, V. and Werlin, S. (2006) Superior mesenteric artery syndrome in children: A 20-year experience. Journal of Pediatric Gastroenterology and Nutrition, 42, 522-525. doi:10.1097/01.mpg.0000221888.36501.f2
[8]	Verhoef, P.A. and Rampal, A. (2009) Unique challenges for appropriate management of a 16-year-old girl with superior mesenteric artery syndrome as a result of anorexia nervosa: A case report. Journal of Medical Case Reports, 3, 127. doi:10.1186/1752-1947-3-127
[9]	Ikegaya, H., Nakajima, M., Shintani-Ishida, K., Uemura, K. and Yoshida, K. (2006) Death due to duodenal obstruction in a patient with an eating disorder: A case report. International Journal of Eating Disorders, 39, 350-352. doi:10.1002/eat.20263
[10]	Reddymasu, S., Banks, D.E. and Jordan, P.A. (2006) Acute pancreatitis in a patient with malnutrition due to major depressive disorder. American Journal of Medicine, 119, 179-180. doi:10.1016/j.amjmed.2005.09.023