Spontaneous air leak syndrome: A very rare pulmonary complication of an eating disorder

Introduction. Eating disorders are characterized by persistent body dissatisfaction and unhealthy weight control. Spontaneous air leak syndrome (ALS) is a rare but potentially fatal complication of a perennial eating disorder that can lead to malnutrition with hypoproteinemia. We present a young male suffering from anorexia nervosa who developed a severe form of spontaneous ALS. Case report. The 25-year-old male patient was initially treated for problems with an eating disorder of the persistent anorexia nervosa type. He deliberately lost about 40 kg during the previous four years. During hospital treatment, the patient suddenly developed severe pain in the abdomen, for which he was urgently referred to a surgeon. He was admitted to the Intensive Care Unit exhausted and afebrile, with the abdomen below the level of the chest and diffuse painful tenderness, with peristalsis audible and petechiae present on the skin of the back, arms, and thoracic wall. Computed tomography of the thoracoabdominal region was performed, which showed air in the mediastinum, in the spinal canal, around the stomach, in the rectum, and in the small pelvis. After an emergency laparotomy, a drainage of the abdominal cavity and intraoperative esophagogastroduodenoscopy were performed. The patient developed neurological complications postoperatively. After a successful recovery, he was treated psychiatrically on an outpatient basis and monitored for several months. Further similar complaints did not occur. Conclusion. Patients with nutrition-al disorders should be closely monitored because a significant protein deficit with spontaneous ALS can occur. Timely diagnosis and treatment can prevent further somatic deterioration and save the patient?s life.