Complication Of Anorexia Nervosa Research Articles

How Should the Clinician Evaluate and Manage the Cardiovascular Complications of Anorexia Nervosa?

Five to twenty percent of patients with anorexia nervosa die from their illness. One half of those patients die of medical complications (Steinhavsen, 2002). Malnutrition, dehydration, and electrolyte abnormalities may precipitate death by inducing heart failure or fatal arrhythmias. Patients and their families commonly call upon physicians to evaluate acute and ongoing risks of malnutrition and purging behaviors. Concerns about medical compromise currently tend to determine or influence insurance coverage of medical and psychiatric treatment of patients with eating disorders. There is very limited published data to guide clinicians in the evaluation, ongoing monitoring, or treatment. Surprisingly, no consensus exists regarding recommendations for either the ongoing evaluation of cardiac parameters or the clinical implications of common findings.

Diffuse soft tissue emphysema in anorexia nervosa: A case report

Anorexia nervosa (AN) is an eating disorder that occurs mainly among young females and its prevalence has increased in recent decades. We reported a patient with AN with spontaneous diffuse soft tissue emphysema and bicytopenia, both of which are very rare complications of AN. Our patient, a 20-year-old woman, had lost 41.6% of her previous body weight within 9 months. Her body mass index was 10.8 and amenorrhea had persisted for 5 months. After admission, she was diagnosed with AN-restrictive subtype. She was noted to have crunching sounds in the neck and upper chest wall during hospitalization. A chest X-ray and chest computed tomography scan both revealed diffuse soft tissue emphysema including subcutaneous emphysema, pneumomediastinum, and pneumoretroperitoneum. Diffuse soft tissue emphysema improved gradually and completely resolved on the 21st day of hospitalization. This condition seems to be benign and only a short period of hospitalization is required.

Testosterone Administration in Women With Anorexia Nervosa

Complications of anorexia nervosa (AN) include marked bone loss, cognitive dysfunction, and major depressive disorder. A lifetime prevalence of depression as high as 68% has been reported in women with AN. Because testosterone (T) increases bone density and may lessen depression in hypogonadal men, the investigators proposed that short-term testosterone, given in physiological doses, would promote bone formation, reduce depressive symptoms, and improve spatial cognition in women with AN. The study group included 33 women who weighed less than 85% of ideal body weight and whose serum free T was less than the median of the reference range for premenopausal women. All of them had been amenorrheic for 3 months or longer, and all exhibited psychiatric features of AN. Participants were randomized to receive transdermal T in a dose of 150 or 300 μg or placebo for 3 weeks. The 3 groups were similar demographically and clinically at the outset. Treated patients had significant increases in serum total and free T levels. A majority of women had free T levels at 3 weeks that exceeded the upper limit of normal for premenopausal women. There were no changes in levels of estradiol, sex hormone-binding globulin, dehydroepiandrosterone sulfate, or insulin-like growth factor-I. Elevations of serum free T were most marked in higher-weight patients. Levels of C-terminal propeptide of type 1 collagen were higher during T treatment than in placebo recipients and correlated with the change in free T over 3 weeks. No changes in osteocalcin or bone-specific alkaline phosphatase were noted. The Beck Depression Inventory demonstrated improved mood in depressed women who received T compared with those on placebo (Fig. 4). The mean score improved from the severely to the moderately depressed range. There were no changes in the use or dose of antidepressants during the study period. Testosterone treatment appeared to improve spatial cognition as reflected by scores on a test of visuospatial ability (Fig. 5). The transdermal patches were, in general, tolerated well. Hirsutism scores did not change over 3 weeks. T administration did not lead to significant changes in blood lipid or lipoprotein levels. Low-dose T, administered transdermally, holds promise for promoting bone formation and lessening depression in women with AN, but the present findings must be confirmed in larger and longer-lasting randomized, placebo-controlled studies. At present, testosterone is not recommended for these patients.

Changes in bone mineral density, body composition and biochemical markers of bone turnover during weight gain in adolescents with severe anorexia nervosa: a 1-year prospective study

Osteoporosis is a serious complication of anorexia nervosa and in affected adolescents may result in a permanent deficit in bone mass. The pathophysiology of this bone disease has not been clearly defined. In this prospective study of 26 young women with anorexia nervosa aged 13-20 years (mean 16.5) we have measured changes in bone mineral density, total body composition and biochemical indices of bone turnover over 1 year. Over this period there was a mean weight gain of 10 kg and significant height gain with baseline and final values for body mass index of 14.2+/-1.7 and 17.6+/-2.3 kg/m2 (P<0.001). However, no significant changes were seen in bone mineral density in the spine or proximal femur during the study; total body bone mineral content was significantly higher than baseline at 3 months and 12 months (P=0.001 and P<0.0001), but total body bone mineral density at 3 months was significantly lower than baseline (P=0.003). Serum osteocalcin and bone-specific alkaline phosphatase values increased significantly and remained higher than baseline at all time points whereas urinary NTX/creatinine excretion showed a non-significant increase over the first 6 months of the study, but at 12 months, the mean value was significantly lower than baseline. Mean serum 25-hydroxyvitamin D levels showed a significant decrease at 6 months (P<0.05), but returned towards baseline thereafter. There was a significant increase in serum parathyroid hormone levels at all time points compared to baseline, these occurring within the normal range. These results indicate that although weight gain in young anorexics is associated with linear growth, bone mineral density does not increase. Whether this deficit can be corrected subsequently requires longer-term prospective studies.

Bacterial infections in anorexia nervosa: Delayed recognition increases complications

We compared the natural history of bacterial infection in patients with anorexia nervosa (AN) with controls, and assessed which of a range of patient characteristics were associated with infection, fever response, and the rate of infectious complications in AN patients. The charts of 311 consecutive hospital admissions of AN patients were reviewed. Patients who had a bacterial infection while in the hospital were compared with the AN patients who did not have an infection, with respect to a range of demographic and disease variables. Fever response and infection complication rate also were evaluated in AN patients with a bacterial infection and in nonanorectic control subjects admitted with a bacterial infection. AN patients with a bacterial infection showed a reduced fever response, were often difficult to diagnose because of fewer signs and symptoms, and infection became more frequent with increasing patient age. A reduction in fever response and the signs and symptoms of infection significantly delayed diagnosis in AN patients and increased the complication rate from bacterial infection. We recommend that an increased index of suspicion and an early complete blood count and bacteriologic cultures be adopted for the investigation of bacterial infection in AN patients.

Muscle mass depletion predicts medical complications in anorexia nervosa

Muscle mass depletion predicts medical complications in anorexia nervosa

Medical complications of anorexia nervosa

Anorexia nervosa is a serious systemic disease affecting virtually all major organ systems. It is frequently undiagnosed, or there is a significant delay in the diagnosis. Anorexia nervosa is one of the few major medical diseases where patients frequently do not seek help and may actively hide their symptoms, making it especially hard for physicians to diagnose and treat. Anorexia has many endocrine and reproductive complications, including amennorhea or irregular menses, delayed puberty, changes in ovarian morphology, and infertility. Women with anorexia have worse pregnancy outcomes; pregnancy itself may also worsen their symptoms of anorexia. Anorexia nervosa is a disease with high morbidity and mortality; patients may die, especially from cardiovascular complications. Anorexia also can cause gastrointestinal, renal, biochemical, hematologic, dermatologic, and metabolic complications. Comorbid psychiatric illnesses occur in greater than 50% of patients with anorexia. Ob/Gyn physicians must know how to adequately assess patients for the presence of anorexia and understand basic treatment principles.

The Effect of Estrogen-Progestin Treatment on Bone Mineral Density in Anorexia Nervosa

Introduction: Osteopenia is a serious complication of anorexia nervosa (AN). Although in other states of estrogen deficiency, estrogen replacement therapy increases bone mass, its role in AN remains unresolved. Study Objective: To study the effect of estrogen-progestin administration on bone mass in AN. Design, Setting, and Participants: A prospective observational study of 50 adolescents with AN (mean age 16.8 ± 2.3 yrs) was conducted in a tertiary referral center. Main Outcome Measures: Bone mineral density (BMD) of the lumbar spine and left hip were prospectively measured using dual-energy x-ray absorptiometry at baseline and annually. Interventions: Twenty-two subjects received estrogen-progestin and 28 standard treatment (Rx) alone. Estrogen-progestin was administered daily as an oral contraceptive containing 20–35 mcg ethinyl estradiol. All subjects received calcium supplementation and the same medical, psychological, and nutritional intervention (standard Rx). Mean length of follow-up was 23.1 ± 11.4 months. Results: At presentation, patients were malnourished (79.5% ± 7.6% IBW), hypoestrogenemic (estradiol 24.7 ± 10.7 pg/mL), and had reduced bone mass (lumbar spine BMD −2.01 ± 0.69 SD below the young adult reference mean). Ninety-two percent of subjects were osteopenic and 26% met WHO criteria for osteoporosis. Body weight, and no treatment group, was the major determinant of BMD. At one-year follow-up, there were no significant differences in absolute values or in net change of lumbar spine or femoral neck BMD between those who received estrogen-progestin and those who received standard Rx (80% power of finding a 3% difference in BMD at 1 yr). In those followed for 2–3 yrs, osteopenia was persistent and in some cases progressive. Conclusion: In our study population, estrogen-progestin did not significantly increase BMD compared with standard Rx. These results question the common practice of prescribing hormone replacement therapy to increase bone mass in AN.

Osteoporosis: Prevention and treatment in anorexia nervosa

One of the most serious and potentially permanently disabling medical complications of anorexia nervosa is osteoporosis, which greatly increases the long-term risk of bone fractures. The decreased bone density in patients with anorexia nervosa (AN) is due to the many effects on bone metabolism of amenorrhea, reduced levels of insulin growth factor-1 (IGF-1), high cortisol levels and weight loss. Although estrogen replacement therapy is clearly efficacious in preventing postmenopausal osteoporosis, its efficacy in AN is uncertain. Clinicians caring for patients with AN need to be aware of this because, despite such therapy, there may be an inexorable decline in bone mineral density in what is a relatively young group of patients. AN frequently has its onset during adolescence, when peak bone mass is normally reached, and an anorectic episode in youth may permanently impair skeletal integrity and lead to debilitating fractures and pain. It is important to recognise this formidable risk, counsel AN patients about the longterm and possibly permanent sequelae of low body weight, use densitometry to screen for bone loss and treat it accordingly. The most effective treatment is still early weight restoration and the resumption of menses.

Physiologic regulators of bone turnover in adolescents with anorexia nervosa

s of Research Presentations Presented at the Annual Meeting of The Society for Adolescent Medicine—March 2002 SESSION I NEW INVESTIGATOR AWARD ELIGIBLE SCIENTIFIC RESEARCH PAPERS PHYSIOLOGIC REGULATORS OF BONE TURNOVER IN ADOLESCENTS WITH ANOREXIA NERVOSA Catherine M. Gordon, M.D., M.Sc., Elizabeth Goodman, M.D., S. Jean Emans, M.D., Estherann Grace, M.D., Kelly A. Becker, B.A., Clifford J. Rosen, M.D., Caren M. Gundberg, Ph.D., Meryl S. LeBoff, M.D. Division of Adolescent and Young Adult Medicine, and Division of Endocrinology, Children’s Hospital, Boston; Division of Adolescent Medicine, Children’s Hospital of Cincinnati, Cincinnati, OH; St. Joseph Hospital, Bangor, ME; Department of Orthopedics, Yale-New Haven Hospital, New Haven, CT; Division of Endocrine/Hypertension, Brigham and Women’s Hospital, Boston, MA. Purpose: Profound osteopenia is a frequent and often irreversible complication of anorexia nervosa (AN), but controversy exists around the mechanisms responsible for the bone loss of this disease. The goal of this study was to clarify the role of specific physiologic regulators of bone turnover in adolescents with AN. We sought to determine correlates of bone mineral density (BMD), with a focus on the contributions of exercise, specific indices of body mass, and adrenal androgens. Methods: Sixty-one young women with AN were studied. Anthropometric data were acquired, and BMD and body composition measured by dual energy x-ray absorptiometry (DXA). Serum samples were obtained for adrenal and sex steroids, insulin-like growth factor I (IGF-I), proresorptive cytokines, and bone formation markers (osteocalcin and bone-specific alkaline phosphatase), and urine for bone resorption markers (N-telopeptides, NTx). Results: Forty-seven percent of patients with AN had osteopenia of the lumbar spine, and BMD was positively correlated with weight (r .46, p .001), height (r .33, p .008), and weekly exercise (r .36, p .006), and inversely correlated with duration of AN (r .26, p .041). BMD of the hip was positively correlated with weight (r .39, p .002) and exercise (r .42, p .001), and negatively correlated with duration of amenorrhea (r .27, p .044). Levels of dehydroepiandrosterone sulfate (DHEAS), IGF-I, and bone formation markers were below that expected for age, while NTx levels were elevated. DHEAS levels were inversely correlated with NTx (r .40, p .004). IGF-I was directly correlated with BMI (r .32, p .014), percentage body fat (r .31, p .034), and the bone formation marker, osteocalcin (r .32, p .015). Proresorptive cytokine levels were low or undetectable. Conclusions: These results suggest that exercise, height, and weight are positive predictors of BMD in AN, and duration of disease and amenorrhea are negative predictors. If cautiously prescribed, exercise may be a lifestyle factor that could augment bone density in adolescent girls with AN. DHEAS was inversely correlated with bone resorption markers, suggesting a relationship between this adrenal steroid and increased bone resorption in AN. IGF-I was correlated with body mass and bone formation indices. The unexpected finding of low proresorptive cytokines suggests that other mechanisms contribute to the increased bone resorption seen in AN. A NEW PROBLEM IN PEDIATRIC AND ADOLESCENT MEDICINE: THE PSYCHIATRIC BOARDER Jonathan M. Mansbach, M.D., Elizabeth Wharff, Ph.D., S. Bryn Austin, Sc.D., Katherine Ginnis, M.S.W., Elizabeth R. Woods, M.D., M.P.H. Children’s Hospital Boston, Harvard Medical School, Boston, MA. Purpose: Due to the shortage of pediatric and adolescent mental health services, pediatric patients requiring psychiatric hospitalization may be admitted to a medical service only because there are no available inpatient psychiatric beds. These patients are termed psychiatric ‘boarders.‘ The goals of this study were to describe the extent of the boarder crisis and to compare the characteristics of patients successfully placed into psychiatric facilities from the Emergency Department (ED) to those requiring admission to the medical service as a boarder. A psychiatric facility was considered an inpatient psychiatric unit or acute residential treatment center. Methods: We conducted a retrospective cohort study. The cohort consisted of all patients presenting to a large pediatric ED who required inpatient psychiatric admission between July 1, 1999 and June 30, 2000. Extensive data were collected at the time of ED evaluation by psychiatrists, psychologists, and psychiatric social workers. Patients were excluded if they needed inpatient medical stabilization or treatment prior to psychiatric placement. The outcomes were validated using computerized medical records and an inpatient psychiatric consult log. Multivariate logistic regression was used to estimate the odds of being boarded associated JOURNAL OF ADOLESCENT HEALTH 2002;30:92–105 © Society for Adolescent Medicine, 2002 Published by Elsevier Science Inc., 655 Avenue of the Americas, New York, NY 1001

The effects of estrogen administration on bone mineral density in adolescents with anorexia nervosa

Profound osteopenia is a serious complication of anorexia nervosa (AN). The aim of this work was to study the effect of prolonged AN on lumbar spine bone mineral density (BMD) and to determine whether oral estrogen administration prevents bone loss in women with this disorder. Thirty-eight amenorrheic women with AN (mean age: 17.3 years) were treated with estrogen (50 microg of ethinyl estradiol) and gestagen (0.5 mg of norgestrel) during 1 year. Clinical variations, biochemical indices and BMD were studied at three different time points, including after a period of amenorrhea of at least 12 months (n=38), after the administration of estrogens for 1 year (n=22), and after a 1-year follow-up period (n=12). Initial mean BMD was significantly lower than normal (-2.1+/-0.8 s.d.) and less than -2.5 s.d. below normal in 38% of the women with AN. The estrogen-treated group had no significant change in BMD even after the follow-up period and partial recovery of weight. Estradiol and total IGF-I levels were significantly lower throughout the study. All subjects had normal thyroxine (T(4)) and TSH levels and calcium metabolism. However, total tri-iodothyronine (T(3)) was decreased in all anorexic subjects in the first and second study points and were within normal limits after the follow-up period. (1) Estrogen replacement alone cannot prevent progressive osteopenia in young women with AN. (2) Other factors, such as the loss of weight, the duration of the amenorrhea and the low levels of total insulin-like growth factor-I (IGF-I) could contribute to the loss of bone mass in women with this disorder.

Hormone replacement therapy (Hrt) And bone mineral density in anorexia nervosa: A 3-YEAR prospective observational study

BACKGROUND: Osteopenia is a serious complication of anorexia nervosa. Although in other states of estrogen deficiency, estrogen replacement therapy increases bone mass, its role in anorexia nervosa remains unresolved.OBJECTIVE: To study the effect of estrogen-progestin administration on bone mass in anorexia nervosa.DESIGN: A longitudinal prospective observational study.METHODS: Bone mineral density (BMD) of the lumbar spine and left hip were prospectively measured using dual energy X-ray absorptiometry at baseline and annually in 50 adolescents with anorexia nervosa (mean age 16.3 ± 1.9 years). All subjects received calcium supplementation and the same medical, psychological and nutritional intervention (Standard Rx). 22 subjects received HRT and 28 received standard Rx alone. HRT was administered daily as an oral contraceptive pill containing 20-35 mcg ethinyl estradiol. Mean length of follow-up was 22.7 ± 11.7 months.RESULTS: At presentation, patients were malnourished (79.5 ± 7.6% IBW), hypoestrogenemic (estradiol 31.2 ± 13.8 pg/mL) and osteopenic (lumbar spine BMD −2.01 ± 0.69 SD below mean for age). 92% of subjects were osteopenic and 26% met WHO criteria for osteoporosis. Body weight and not treatment group, was the major determinant of BMD. At one-year follow-up, there were no significant differences in absolute values or in net change of lumbar spine or femoral neck BMD between those who received HRT and those who received standard Rx (80% power of finding a 3% difference in BMD at 1 year). In those followed for 2-3 years, osteopenia was persistent and in some cases, progressive.CONCLUSION: In our study population, HRT did not significantly increase BMD compared with standard Rx. These results question the common practice of prescribing HRT to protect bone mass in anorexia nervosa.

Pericardial effusions in anorexia nervosa.

Anorexia nervosa is an eating disorder that may be accompanied by cardiac symptoms of varying severity. So far disturbances like arrhythmias, mitral valve prolapse and loss of cardial ventricle mass have been described. Other somatic complications consist of electrolyte and acid-base imbalances, which in turn influence cardiac function. Between 1990 and 1999 we observed ten case reports from inpatient anorexic female adolescents, who developed pericardial effusions in the course of their illness. The diagnosis and course was revealed by echocardiography. No signs of heart failure could be noticed. In eight patients pericardial effusion remitted completely or partly by a concurrent increase in weight. A distinct pathophysiology for the development of pericardial effusion could not be revealed, but a correlation to restoration of weight seems to exist. Our report suggests that pericardial effusions are more frequent cardiac complications in anorexia nervosa than previously known. In most cases the clinical significance is doubtful.

The effects of anorexia nervosa on bone metabolism in female adolescents.

Osteopenia is a frequent, often persistent, complication of anorexia nervosa (AN) in adolescent girls and occurs during a critical time in bone development. Little is known about bone metabolism in this patient population. Therefore, we measured bone density (BMD) and body composition by dual energy x-ray absorptiometry, nutritional status, bone turnover, calcium, and hormonal status in 19 adolescent girls with AN (mean +/- SEM, 16.0+/-0.4 yr) and 19 bone age-matched controls. The mean duration of AN was 19+/-5 months. Spinal (L1-L4) osteopenia was common in AN. Lumbar anterioposterior BMD was more than 1 SD below the mean in 42% of patients, and lateral spine BMD was more than 1 SD below in 63% of patients compared with controls. Lean body mass significantly predicted lumbar bone mineral content (r = 0.75; P < 0.0001) in controls only. In AN, duration of illness was the most significant predictor of spinal BMD (lumbar: r = -0.44; P = 0.06; lateral: r = -0.59; P = 0.008). AN adolescents with mature BA (15 yr and greater) were hypogonadal [estradiol, 16.2+/-1.9 vs. 23.3+/-1.6 pg/mL (P = 0.01); free testosterone, 0.70+/-0.17 vs. 1.36+/-0.14 pg/mL (P = 0.01)] although dehydroepiandrosterone sulfate and urinary free cortisol levels did not differ. Leptin levels were reduced in AN (2.9+/-2.1 vs. 16.5+/-1.8 ng/mL; P < 0.0001). Insulin-like growth factor I (IGF-I) was reduced in AN to 50% of control levels (219+/-41 vs. 511+/-35 ng/mL; P < 0.0001) and correlated with all measures of nutritional status, particularly leptin (r = 0.80; P < 0.0001). Surrogate markers of bone formation, serum osteocalcin (OC) and bone-specific alkaline phosphatase (BSAP), were significantly (P = 0.02) reduced in AN vs. controls (OC, 39.1+/-6.4 vs. 59.2+/-5.2 ng/mL; BSAP, 27.9+/-4.0 vs. 40.6+/-3.4 U/L). The majority of the variation in bone formation in AN was due to IGF-I levels (OC: r2 = 0.72; P = 0.002; BSAP: r2 = 0.53; P = 0.01) in stepwise regression analyses. Bone resorption was comparable in patients and controls. These data demonstrate that bone formation is reduced and uncoupled to bone resorption in mature adolescents with AN in association with low bone density. Lean body mass was a significant predictor of BMD in controls, but not AN patients. The major correlate of bone formation in AN was the nutritionally dependent bone trophic factor, IGF-I. Reduced IGF-I during the critical period of bone mineral accumulation may be an important factor in the development of osteopenia in adolescents with AN.

Anorexia and Osteoporosis

Osteoporosis, the loss of bone mineral density, is an important complication of anorexia nervosa. Often, the progressive diminution in skeletal integrity results in an irreversible weakening of bones despite recovery from anorexia nervosa. This can ultimately result in painful fractures in the spine and hip. Preventive therapy as well as medicinal interventions are available to stop the inexorable loss of bone mass associated with anorexia nervosa. Early diagnosis must be emphasized because of the serious health implications of osteoporosis.

Medical complications of anorexia nervosa.

Anorexia nervosa is often characterized by progressive deterioration in many different organ systems. Most medical complications are the result of starvation and can be reversed with a well-planned refeeding program. While some of the complications of anorexia nervosa are predictable physiologic adaptations to the self-imposed starvation, many others are potentially life threatening. It is therefore incumbent upon all primary care physicians to become familiar with this disorder, because it is increasing in incidence and is commonly burdened by substantial chronicity and recidivism.

Persistent osteopenia after recovery from anorexia nervosa.

Osteopenia is a known complication of anorexia nervosa. Most studies have focused on the features of the illness which predict bone complications. The few reports on recovery have been conflicting, with some studies suggesting restoration of normal bone mass with recovery from anorexia nervosa, while others suggest that the improvement may only be partial. This is the first report of bone density in a long-term recovered group. We measured bone density in the hip and lumbar spine in 18 recovered women, using dual energy X-ray absorptiometry. We found an unexpectedly high incidence of osteopenia, with 14 of 18 women affected. Duration of amenorrhea was the best predictor of reduced bone density. An index of the duration of recovery, relating it to the duration of illness, was also highly correlated with outcome. Our findings have implications, both for the individual and for the economic burden to society. We suggest that the use of oral contraceptives in women recovering from anorexia nervosa needs further investigation. Additional longitudinal studies are clearly warranted.

Physical and Emotional Problems of Elite Female Gymnasts

Within the past five years, two U.S. female gymnasts at the Olympic level, Christy Henrich and Julissa Gomez, died from medical problems related to their sport. Christy died from complications of anorexia nervosa and Julissa from complications of spinal trauma due to a vaulting injury. In this Olympic year, it is timely to discuss the psychological and physical problems associated with competitive women's gymnastics. Women's gymnastics provides a useful framework for viewing worrisome trends in other competitive youth sports. In the United States, organized athletic programs involve at least 20 million children and adolescents each year, with more than 2 . . .

The Gut in Anorexia Nervosa: Keep It Moving!

Constipation is one of the well-known physical complications of anorexia nervosa. Contributing to the constipation are an intestinal musculature weakened by starvation, the centrally mediated physiologic "slow-down" of body metabolism in starvation, and the patient's voluntary fluid restriction. Spontaneously arising constipation is exacerbated by medications that have anticholinergic side effects. In anorexia nervosa, constipation can be much more than an inconvenience, as the following example shows: A 16-year-old girl who had anorexia nervosa became badly constipated, with the radiograph showing impacted stool throughout the colon. She suffered many complications, including pain and the development of intermittent urinary retention, brought on first by anticholinergic medications but worsened by fecal constipation.

Dilatation gastrique aiguë avec nécrose ischémique secondaire: une complication exceptionnelle de l'anorexie mentale. A propos d'un cas

This is a report of a 19 years old woman with anorexia nervosa who presented acute gastric dilatation with infraction. A warness of this complication of anorexia nervosa may lead to its earlier recognition and more timely and favourable treatment.