神経性食欲不振症の経過中に発症した上腸間膜動脈症候群の1例 Superior Mesentric Artery Syndrome in A Case of Anorexia Nervosa
Acute gastric dilatation (AGD) is one of the life-threatening complications which needs accurate diagnosis and appropriate treatment as soon as possible, although it occurs rarely in anorexia nervosa. We have unexpectedly experienced a case of AGD in anorexia nervosa caused by superior mesenteric artery (SMA) syndrome during the early stage of the treatment. An 18-year-old senior highschool girl was admitted to our hospital because of anorexia nervosa without any episodes of bulimia or vomiting. About one year before admission, considering herself overweight she had started dieting and had reduced her weight from 60kg to 33.8kg. After admission, she started taking, 1,000kcal of food by herself in addition to 200kcal of elementary diet by the tube feeding. On the 2nd hospital day, a plain chest X-ray picture showed the left-sided pleural fluid because of the pulmonary tuberculosis. The chest drainage tube was inserted on the 6th hospital day, and she was forced to lie on the bed. On the 8th hospital day, she suddenly felt nauseous and vomited. A plain abdominal X-ray picture showed the sign of AGD. A barium X-ray study on the 11th hospital day proved that the AGD was caused by SMA syndrome, showing vertical cut off sign at the 3rd portion of the duodenum obstructed by the SMA and oral side duodenal loop and the stomach were dilated. She was treated conservatively, and barium meal examination, on the 46th hospital day, proved that the signs of SMA syndrome had disappeared. After the completion of our step-by-step treatment program on the basis of cognitive behavior therapy with anti-tuberculosis drugs, she was discharged at the weight of 46.7kg, and she has been in good condition since then.
心身医学 30(1), 59-65, 1990