A case report of a 22-year-old woman who died after an eating binge underscores the extremely rare but serious consequences of bulimia nervosa.

Early recognition and treatment could potentially prevent such deaths, Dr. Endre Gyurkovics of Semmelweis University in Budapest, Hungary, and colleagues report.

The woman, who was of normal weight and well-nourished, arrived at the hospital with an extremely painful, distended abdomen, Gyurkovics and his team note in the November issue of the International Journal of Eating Disorders. Ultrasound and CT scans showed that her stomach was so distended it had pushed other abdominal organs out of place, while impairing blood flow in major veins.

Gyurkovics and his team performed emergency surgery to remove 11 liters of material from the woman’s stomach. They also identified inflammation in the woman’s bowel due to Crohn’s disease, which required them to remove some of her intestine.

While the surgery was successful, the patient went into shock and died 36 hours later due to massive bleeding. Her parents told the researchers that the woman had received therapy for her “bulimic attacks,” and that over the past several years she had experienced periods of overeating.

The woman’s condition, known medically as acute gastric dilation, was first described in 1833, the researchers note, but just 31 cases have been reported in the medical literature since 1966. And there had been no reports, they add, of dilation so severe that it impaired blood flow resulting in damage to the legs and large intestine, as in the current case.

“Clinicians should be aware that abnormal eating habits can cause severe…complications even in patients who are not diagnosed as having an eating disorder,” the researchers conclude.

SOURCE: International Journal of Eating Disorders, November 2006.