Acute Massive Gastric Dilatation From Binge Eating

Cropped closeup image female touching stomach suffering from severe ache
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Binge eating—or bingeing—is defined as eating a large volume of food at one time and feeling as if you have no control over the amount of food you consume. Binge eating disorder is often diagnosed when bingeing occurs at least once a week for three months.

Many people regard binge eating as a relatively benign eating disorder, especially in comparison to the severe food restriction of anorexia or purging seen with bulimia. And some even believe that isolated episodes of binge eating aren't harmful.

But these assumptions aren't necessarily true. Among other health concerns, a rare consequence of bingeing can be acute massive gastric dilatation, a condition that causes extreme distention of the stomach. If not quickly managed, the condition can result in death. It's important to understand this condition to fully grasp the impact of disordered eating like bingeing.

Acute Massive Gastric Dilatation Defined

To understand acute massive gastric dilatation, it may be helpful to define key terms related to the condition:

  • Gastric dilatation means enlargement or ballooning of the stomach
  • Ischemia means lack of blood flow
  • Necrosis means "death of," as in the death of cells
  • Perforation means "tear," generally in body tissues

Sometimes, the stomach may become so large that it occupies an area of the abdomen from the diaphragm to the pelvis and from the left side of the body to the right side of the body.

Acute massive gastric dilatation occurs when there is extreme distention or enlargement of the stomach.

While the condition is rare, it is encountered in several different scenarios. It can be a postoperative complication after abdominal surgery and it is sometimes seen in patients with disorders including anorexia nervosa, bulimia nervosa, psychogenic polyphagia (extreme desire to eat), or trauma.

The condition is dangerous because it can cause ischemia, necrosis, and perforation of the stomach. In most cases of acute massive gastric dilatation, surgery has been necessary to prevent or to treat the complications. Early diagnosis with prompt gastric decompression may avoid unnecessary surgery.

Case Examples

Though there is limited literature available, the case examples below illustrate the unexpected severity of acute massive gastric dilatation. In these examples, an episode of binge eating went wrong and triggered an urgent need for medical attention.

Anorexia Nervosa

A published case history provides details of a person with a history of anorexia nervosa. Study authors describe a 26-year-old female who came to the emergency department of Massachusetts General Hospital with symptoms that included abdominal pain and nausea. She had been unable to vomit for two hours. Her weight was in the low-normal BMI range and she was described as thin. 

At first, she reported no significant abnormal eating preceding the onset of her pain. But she eventually disclosed a past history of anorexia nervosa, including bingeing and purging, which had occurred in her teens. She said she had gone four years without bingeing but then went on a one-hour binge preceding this presentation brought on by alcohol intoxication and stress.

Medical intervention revealed that her gastric content included approximately two gallons of partially digested food. She was suffering from acute gastric dilatation with some necrosis — which can be fatal if not accurately and quickly diagnosed and treated.

Stomach contents were surgically removed. The woman remained in the hospital for five days and had to maintain a liquid diet even after she was discharged. Eventually, she resumed a typical diet and has since reported no problems.

However, if she had not come to the ER on the night of her binge eating episode, her outcome may have been dire. Study authors noted in their report that early surgical intervention is critical in preventing fatal complications.

Bingeing and Excessive Exercise

Another case report describes a 28-year-old female who came to the emergency room with sudden abdominal discomfort and pain. The cause of symptoms was not reported at the time of admission. Her weight was in the normal to low-normal BMI range.

The woman was suffering from a massive dilatation of her stomach. She was admitted to the hospital and placed in intensive care. Medical evaluation revealed large amounts of undigested food that needed to be surgically removed.

The patient eventually disclosed a history of an eating disorder since childhood. Binge episodes were often followed by compensatory behaviors including food restriction and excessive exercise. At the time of hospital admission, she had been experiencing daily binges (with purging) triggered by work stress.

The woman was discharged 13 days after she first arrived at the hospital. She continued with psychiatric treatment that was initiated in the hospital. Authors of the report note that under similar conditions some patients do not recover and unfortunately pass away. They confirm the severity of this condition as well as the importance of adequate diagnosis and immediate surgical intervention.

No Eating Disorder

In 2016, medical experts published a report of a 17-year-old male with no history of an eating disorder. The young man came to the hospital with pain and distension in the abdomen area and a period of retching without vomiting. He had reportedly fasted about 24-hours for religious purposes. Then, he had a binge-like dinner on the night before he ended up in emergency medical treatment the following night.

He was described as a “healthy boy” other than the abdominal issues. But he was suffering from acute gastric dilatation with ischemia and necrosis of the stomach wall. Medical intervention was required to remove about five liters of free fluid and undigested food in the abdominal cavity.

This episode could have lead to death if the patient had not received a timely medical intervention. The case study authors note that the condition can occur even in those with no diagnosis of an eating disorder.

These cases are just a few that have been reported in the medical literature. But they are a few of the many reasons why binge-eating is dangerous—even when just a single episode is involved. They are also important reminders that medical intervention is key for proper management, and in some cases, for survival.

Causes and Risk Factors

More research is needed to clarify the risks and causes of acute gastric dilatation. A person of any weight may be susceptible to acute massive gastric dilatation. Though there are some factors that may increase your risk of experiencing the condition.

As indicated, binge eating and overeating without control puts you at risk. A higher chance of occurrence has been reported for those who currently have or have a history of an eating disorder versus those who don’t have that history. People who binge should be cautious of fasting and binge eating patterns accompanied by abdominal pain.

Warning Signs of Acute Massive Gastric Dilatation

Key symptoms to watch for include:

  • Nausea
  • Vomiting
  • An inability to vomit
  • Bloating/distension in the abdomen area
  • Sudden onset of abdominal pain

If you notice any of these symptoms, immediate medical attention and treatment can be critical. If massive gastric dilatation is suspected, surgery may be required to avoid more severe complications including necrosis, perforation, shock, and death.

A Word From Verywell

It's not uncommon to have occasional episodes where you eat a little more than you had expected. Sometimes, it may lead to slight discomfort. But binge eating — an episode where overeating gets out of control — is different and can be serious. There can be sudden and severe consequences of bingeing.

If you are someone who binges or if you have a loved one who binges, take steps to get help. You may help save a life by knowing about this rare but potentially deadly condition. Fortunately, successful treatments for binge eating disorder are available.

5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. National Institutes of Diabetes and Digestive and Kidney Disorder. Definition & Facts for Binge Eating Disorder. June 2016

  2. Jung S, et al. Gastric perforation caused by acute massive gastric dilatation: Report of a case. J Med Cases. 2012;3(5):286-289. doi:10.4021/jmc635w

  3. Holtkamp K, Mogharrebi R, Hanisch C, Schumpelick V, Herpertz-Dahlmann B. Gastric dilatation in a girl with former obesity and atypical anorexia nervosa. Int J Eat Disord. 2002;32(3):372-6. doi:10.1002/eat.10098

  4. Lemke J, Scheele J, Schmidt S, Wittau M, Henne-Bruns D. Massive gastric dilatation caused by eating binges demanding surgical intervention: A case report. GMS Interdiscip Plast Reconstr Surg DGPW, 2014;3. doi:10.3205/iprs000050

  5. Dewangan M, Khare MK, Mishra S, Marhual JC. Binge eating leading to acute gastric dilatation, inchemic necrosis and rupture—a case report. J Clin Diagn Res. 2016;10(3). doi:10.7860/JCDR/2016/16530.7450

By Alli Spotts-De Lazzer, M.A., MFT, LPCC, CEDS
Alli Spotts-De Lazzer is a Licensed Marriage and Family Therapist and Certified Eating Disorders Specialist who practices in California.