Rapidly progressing severe coagulopathy and thrombocytopenia in extreme anorexia nervosa patient with small bowel strangulation: A case report

INTRODUCTION: Anorexia nervosa (AN) is characterized by severe dietary restriction or other weight loss behaviors motivated by a strong fear of body weight gain and a disturbed body image. In this paper, we report a case of an extreme AN patient, in whom severe coagulopathy and thrombocytopenia rapidly progressed with strangulation obstruction. PRESENTATION OF CASE: A female patient in her 20's with previous history of AN came to our hospital complaining acute onset abdominal pain. Her body mass index at presentation was 12.1 kg/m(2); thus, she was classified as an “extreme” AN (BMI <15) according to DSM-5 classification. Abdominal CT scan showed small bowel obstruction without strangulation. Although severe leukopenia appeared soon after admission, platelet count and coagulation tests were maintained relatively well. Due to her severe malnutrition, we proposed nutritional therapy and subsequent surgical adhesiolysis; however, she refused any kind of nutritional therapy. On admission day 13, she suddenly developed a strangulation obstruction. At the same time, severe coagulopathy and thrombocytopenia rapidly progressed. Emergency laparotomy was performed using a massive blood transfusion. Bowel strangulation was successfully released; however, intraabdominal bleeding was repeated postoperatively and three more operations were required until complete hemostasis and abdominal closure. After long rehabilitation, she was discharged from our hospital on day 116. DISCUSSION: The medical comorbidities associated with AN extend various organ systems; among them, the hematologic complication can be a life-threatening problem during emergency surgery for a patient with AN. CONCLUSION: Knowledge about the pathophysiology of AN is quite essential for all surgeons.