it is characterized by acute and mostly intense abdominal pain accompanied by peritonism and potentially meteorism , nausea , vomiting and in severe and advanced cases shock . in most cases abdominal pathologies cause this acute condition including  but not limited to  appendicitis , cholecystitis , pancreatitis , mesenteric ischemia , ileus and perforations of hollow organs , . however , also extra - abdominal diseases can present with symptoms of an acute abdomen such as testicular torsion , myocardial infarction or diabetic ketoacidosis . due to the fact that an acute abdomen is always potentially life - threatening , prompt action is required to obtain the diagnosis and to immediately initiate adequate therapy . diagnostically , in addition to clinical examination and analysis of serum parameters , imaging such as sonography , computed tomography ( ct ) and magnetic resonance imaging ( mri ) are foremost in leading to the correct diagnosis . however , as mentioned above , the causes for acute abdominal symptoms are versatile and at times are found in medical areas other than gastroenterology itself . in this study we report on an interesting and unique case in which a psychiatric condition was the underlying disease leading to an acute abdominal picture which required immediate surgical intervention . a 28-year - old woman presented in our surgical emergency unit with a sudden onset of progressive abdominal discomfort and pain . routine laboratory analysis did not show any pathologies , including normal hemoglobin , leucocytes , c - reactive protein ( crp ) as well as serum electrolytes . because of the acute and dramatic clinical presentation we immediately performed a computed tomography of the abdomen . this revealed a massively distended stomach with a cranio - caudal extension of 35 cm reaching the lesser pelvis , however , without evidence for perforation ( figure 1 ( fig . a stomach tube was placed , which , however , did not drain any significant amount of stomach content . we performed a gastrotomy of the gastric antrum and recovered ( over the period of one hour ) a large amount of cementitiously clotted and undigested food scraps from the stomach . the stomach tube as well as the intrabdominal drainage could be removed within the first days after surgery . a gradual reintroduction of liquids was well tolerated . on the sixth postoperative day we performed a radiological imaging of the stomach using contrast medium which revealed a re - tonised stomach of a normal size without evidence for any stenosis ( figure 2 ( fig . subsequently , the patient was allowed to normal food intake , which was well tolerated as well . the postoperatively initiated evaluation of the patient by a psychiatrist revealed that she had been suffering from an eating disorder since her childhood . temporarily , her body mass index ( bmi ) had dropped to 11 kg / m . at consultation in our clinic however , the patient reported on daily binge eatings caused by conflicts at her workplace . this had also occurred on the day of hospital admission , however on this day , the routinely self - induced vomiting after the binge attack failed . in a good status of health here , we report on an unusual case in which a binge attack in a young woman suffering from an eating disorder caused a massive dilatation of her stomach . this dilation was not reversible either by self - induced vomiting or by drainage using a stomach tube . some other authors have reported on cases in which eating disorders such as anorexia nervosa or bulimia nervosa lead to acute gastric dilatation , , , . in line with the higher incidence of eating disorder in young females , mostly women in the age between 14 and 30 years were affected . in some cases , the so - called superior mesenteric artery syndrome has been suggested to cause or at least promote gastric dilatation in patients with eating disorders , . for this syndrome it has been proposed that malnutrition leads to the shrinkage of a fad pad localized between the aorta and outlet of the superior mesenteric artery . this , in turn , may cause compression of the duodenum thereby promoting gastric dilatation , in particular in cases when eating binges occur . in the reported case of this study , immediate imaging revealed the diagnosis and emergency explorative laparotomy and gastrotomy allowed for full recovery of the patient without complications or any residuals . this prompt and direct action including emergency laparotomy appears to be justified and essential , given the fact that some authors have reported severe complications such as gastric perforation and/or necrosis in patients with similar conditions , . furthermore , in some cases extended surgical approaches such as partial gastrectomy or even gastric resection were required . the fact that some patients did not recover and , unfortunately , passed away , confirms the severity of this condition as well as the importance of adequate diagnosis and immediate ( surgical ) therapy .