Death due to neurogenic shock following gastric rupture in an anorexia nervosa patient*
"Take notice of her position, the discoloring of her limbs and her stomach.
Case notes:
She was in full rigor mortis - which is present from 12-72 hours. The bruises set the time frame at around 8+ hours.
Her eyes had clouded, which happens at progressively from about 2 -4 hours on.
If you look really closely at her stomach, you can see a greenish tint, which is a typical sign of her internal organs decaying - called livor mortis. I think this process may have been accelerated as her insides were digested since it normally takes a few days to set in.
The bruises called for the autopsy. Because of her position when her stomach exploded, it spilled all its contents into her body cavity. The blood and food settled around her anus and vagina and caused what looked like "fresh bruises." So to rule out sexual [assault, etc.], they had to autopsy.
When they did the autopsy, they found that her stomach had been extended from where your ribs meet each other all the way to her pubic bone, right behind that pad of fat above the genitals (mons pubis). And her stomach had a large rip in it...
She also had some other abnormalities going on. Her heart was small and displayed typical characteristics of a starving heart - destroyed muscles and dead immune cells (lipofuscin bodies).
Her brain had swelled, my guess due to the massive increase in blood flow after her stomach ruptured - it had started to squeeze out her skull before she died.
She also had evidence of focal pneumonia in her lungs - not really surprising as starvation hurts the immune response to viruses.
Like a typical binger, her stomach was dying before it ripped. What I mean is that every time we binge our stomachs expand, if they expand far enough, the vessels supplying them blood are crushed - cutting off the blood supply to that area, killing the tissue. That area is weakened and the next binge of that caliber becomes more dangerous. Purging just adds fuel to the fire by increasing stomach pressure above and beyond the natural level.
But believe it or not the ruptured stomach didn't kill her. A natural reaction did.
When the stomach exploded, her body responded with a typical immune reaction. It dilated her blood vessels, her blood pressure dropped, she blacked out, and her heart slowed down and stopped. They also did a tox screen and found nothing. Potassium levels are obviously of no use as when you die potassium leaks out of your cells.
"...her stomach ripped after eating 5.6 liters [picture above] of food."
Another things to note about this. Back in the 1800s, they determined that the stomach should only be able to hold 4 liters of stuff (by filling corpses). To surpass this, we have to adapt our stomach sizes - resulting in gastric dilatation.
Ruptures via overfilling the stomach appear along the lesser curvature of the stomach, whereas vomiting induced ruptures normally occur along the greater curvature and fundus (the top of the stomach) - it's unusual that her stomach ripped how it did, right down the front.
Apart from the intellectual value of the report it does illustrate an important point - the endpoint of these diseases is very ugly.
There is no glamour or beauty spending your last living moments over a toilet."
*References:
Lähde I. Sinicina, , H. Pankratz, A. Büttner and G. Mall
Institute of Legal Medicine, Ludwig-Maximilians-University, Frauenlobstraße 7a, D-80337 Munich, Germany
Received 26 March 2004; accepted 26 October 2004. Available online 13 December 2004.
Abstract:
"We report a case of fatal gastric rupture discovered after death, which developed due to a bulimic attack of a 19-year-old woman suffering from anorexia nervosa. An autopsy revealed an acute gastric dilatation and rupture without commonly observed ischemic damage of gastric wall structures. However, it may be difficult to determine the cause of death despite the marked findings. The death as a consequence of neurogenic shock accounts for all the results of gross examination and histologic analysis. This case is the first reported case of fatal gastric rupture of an anorectic patient discovered after death."
Links:
http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6T6W-4F14YXR-2&_user=10&_coverDate=12%2F01%2F2005&_alid=235096972&_rdoc=1&_fmt=high&_orig=browse&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=fff6be6e8ec025127b598a7af4c8704d
http://www.crazycaterpillar.com/
Posts
38 comments:
I have been so scared of this happening to me. I am a healthy weight now but I still binge and purge. I have been losing weight again but this post has really scared me into contiuing with my treatment. The sick thing is that when I was 19, 28kgs and binging on at least a kilo of food at the time I was down at my local hospital in a small town begging for help and they told me they couldn't do anything for (me by the way health care is free in Australia). I have since moved to the city and the support is unbelievable. The problem is the support we are not getting when we are litteraly calling out for help. Thank you so much. I have been dissassociated from the world the past week but now I remember the pain I am getting my self in to. Bless you medusa.
{{{anonymous}}}
I wish I could reach through my computer monitor and give you a great big hug. Thank you so much for taking the time to comment. I'm so happy you moved to the city where you found support and treatment for your ED.
The statistics showing the number of people who die from gastric rupture from binging and purging are alarming.
Please continue with your treatment, anonymous. I know you can beat this binge-purge cycle.
Sending positive, healing thoughts your way...
Hugs,
Medusa
OH. MY. GOD.
I couldn't look at this picture without feeling ill. I am terrified that will be me someday. I've been anorexic/bulimic for 9 yrs now, and I'm losing hope. At the age of 20, I weighed 57lbs, basically like the photos of Aimee from Dr Phil. Thanks to a great team of doctors who were not even ED specialists, I survived that phase of my disorder. (There were no places in ED programmes for me at the time. I live in Canada where the treatment is free but the waiting lists are horrendous.)
Since then I have been everything from slightly underweight to slightly overweight, as the bulimia (and just binge eating) took hold. If you had told that emaciated young woman (me) of 3 yrs ago that she would be verging on overweight, she wouldn't have believed you. My natural weight is in the 105 to 110 range, I feel most comfortable around 80 and I'm now about 130. Like the girl in this photo, I eat to the point of pain, sometimes until I can't breathe properly. What is most terrifying is that I have begun to eat without throwing up, and that's why i've gone from 100 to 130 in about a month.
Thank you for posting this photo. It's disgusting and alarming, but necessary.
~ Katja
(((Katja))) Thanks so much for sharing your story and for your comments. I can't imagine how difficult it would be to face the struggles which you are dealing with daily. My heart goes out to you.
I am Canadian too and am so frustrated at how difficult it is to get ED treatment here. Aimee Moore, who lives in Stratford, Ontario, is currently in treatment in Alabama because no facility in Canada is able to treat her. What a sad state of affairs this is.
Please don't give up or lose hope, Katja. There is help out there.
There is a great Canadian ED website called We Bite Back. It has great resources and a forum for members who are battling EDs. Please think about joining it as the members there are wonderful and so supportive.
Here is the link to the website:
http://www.webiteback.com/
Take care, Katja. Please keep in touch and let me know how you're doing. Sending hugs and healing thoughts your way...
~ Medusa
Thank you for the link; we need more places of support online.
One thing I wanted to add, and this may sound horrible, but in some small way it helps me just to get it out there... Sometimes I wish I could just go back to the way I was when I was in the anorexic phase of my disorder. In the years before all the medical problems started, I wore it as a "badge of honour" and there are times when I miss it so much. That's sick, isn't it?
It's just that bulimia and/or compulsive eating seem so much more shameful. Our society is conditioned to be repelled by lack of control with food and by excess weight. Of course being overweight is unhealthy, but those of us with EDs glorify emaciation, even when it's just as or even more unhealthy.
It's so hard to deal with my current situation. Being thin meant I was in control; in my mind those were my "happy days". Now I'm just weak and ashamed. If anything, this has taught me I truly have a problem and that it's the food that's controlling me, not the other way around.
Katja, you're very welcome for the link.
"One thing I wanted to add, and this may sound horrible, but in some small way it helps me just to get it out there..."
It doesn't sound horrible at all. Talking and writing is part of the healing process, and is a very positive step.
You are an eloquent and thoughtful writer, Katja. I hope you continue to write and share your experiences on your road to recovery.
All the very best to you...
Medusa
I just wanted to say a HUGE thank you again!
Webiteback is the most caring community of people I have ever encountered. I've been a member for less than a week and I'm wondering what I did before without all of them!!!
Thank you for pointing me towards a place where I feel more support than I have in a long time.
Many (((hugs))) to you! :)
Katja, you are so welcome!
I can't tell you how thrilled I am that you joined webiteback! It is such a fabulous site and I knew you would find friendship, support and encouragement there.
And thank you from the bottom of my heart for your kind words. Please keep in touch, Katja, and let me know how you're doing. I'm pulling for you, sweetie :^)
Hugs,
Medusa
I don't have an eating disorder, per se. I simply do not eat when stressed because I feel sick when I do - however I want to applaud you, Medusa. What you are doing in your blog here is wonderful and I pray that you succeed in reaching more people, girls like this need help.
(((Anonymous)))
Thank you so very much for your very kind comments.
I do hope that by reading of the deadly consequences of bulimia, anorexia, and other eating disorders those who are suffering from EDs will seek the professional help they so desperately need.
Again, anonymous, thanks SO much for taking the time to comment. I appreciate it so much.
thankyou so much. I really really appreciate this. =)
(((Sash)))
You're so welcome. Thank you so much for your comment.
xoxo
Mandi is my name and this website moved me because I am 5'5 and I way 287..I love to eat more than just about anything.I get a rush from it.Do any other ED's feel that way.I have been to OA meetings before and I just do not seem to understand them.I was molested as a child from my grandfather and I sometimes feel like if I get really really fat that no man will want to be with me or hurt me.I am sure that sounds crazy but I feel quite protected in that way.When i was growing up my mom used to tie up the pantry so I would not eat all the food.I was 8 when i started getting molested.i was eXstreamly mad at my Mom so I figured eating was fun no friend no fun just food.I am 29 now and the heavyist I have ever been.....
(((Mandi)))
Please believe me that you are not crazy. You are not alone, Mandi. Many who have been sexually molested overeat in an effort to make themselves sexually undesirable to the opposite sex.
There is a wonderful support site which I would recommend you join. It's called We Bite Back.
Many women who post there have experienced what you have gone through. I have recommended this site to others in the past and they have nothing but praise for the help they have received there. Please take a moment to check it out:
We Bite Back
I wish you all the very best. Please keep in touch, Mandi, and let me know how you're doing.
Hugs,
Medusa
I am always afraid of these things happening to me. I've been fighting Anorexia for many years now, and I have had quite a few scares. I'm always terrified that my next b/p will be the last, or that I'll fall down while on a run and be all alone.
This world is so scary - my world, more so than the real world.
Thank you for posting this
(((Sadie)))
I'm so sorry you're suffering so much and that your world is so scary.
I truly hope you'll be able to beat this thing, and wish you every success in your fight.
Take care, sweetie, and best wishes to you.
Medusa
Lau
I eat and eat and eat, but I dont throw up. I always wondered about the pain i was feeling during and after a bing the way my stomach hurt for days after ward and the way my muscles and joints and entire body felt soo week after wards. I wondered about these things and tried to deny that they were coused by my overeating. I even did reseach on the side-effects of overeating besides the obvuious weight-gain. Thank-you Medusa I need something like this story to be the clear proof that I need to stop doing this to myself before I become the girl in the picture.
I don't even know what to say to you Medusa or where to start. Well I am bipolar, I've been going on six-month extreme up and down cycles for over 10 years and I can pretty much plan my life around it and tell you exactly what will happen and when...
Well I'll go for my standard six months, eating an apple and 7 crackers a day...(this half of it I never have had a problem with because it makes me perfect size) but then I'll go into the binge eating for the opposite cycle, just eating to the point where I can barely breathe, I'm about to cry or pass out from the pain and my heart beats so hard I wonder if maybe I should be on the way to the ER... anyway, I've been along for the ride on this extreme cycle for a long, long time.
Now I pride myself on being strong, not a wimp in any way, won't ever turn away from anything gruesome... NEVER have I seen or read anything that affected me the way this story did... I felt like walls were spinning and closing in on me and I was shrinking in my seat. My mind just kept placing me into the picture, into her position. How sure she must have felt that it was just another binge and purge and that afterwards everything would be fine. What it must have felt like when it happened.
I've been crying and crying, can't stop, and going over this story over and over pretty much all night now... I think the fear of this story has pushed me to my edge and I DON'T EVER WANT TO STARVE OR BINGE AGAIN. I don't know if it's possible to get to a point where you can just stop all the sudden like that, but that's how I feel right now and it's all because of you and your blog.
Thank you SO MUCH for telling somehow the only story that's ever gotten through to me, and you have no idea what this means to me. I don't have the slightest clue where I go from here, but hopefully I can eventually find myself somewhere in the middle (instead of either at the top of Everest or in the darkest depths of hell). I will keep her picture and her story in the back of my mind for the rest of my life.
I don't even know what to say to you Medusa or where to start. Well I am bipolar, I've been going on six-month extreme up and down cycles for over 10 years and I can pretty much plan my life around it and tell you exactly what will happen and when...
Well I'll go for my standard six months, eating an apple and 7 crackers a day...(this half of it I never have had a problem with because it makes me perfect size) but then I'll go into the binge eating for the opposite cycle, just eating to the point where I can barely breathe, I'm about to cry or pass out from the pain and my heart beats so hard I wonder if maybe I should be on the way to the ER... anyway, I've been along for the ride on this extreme cycle for a long, long time.
Now I pride myself on being strong, not a wimp in any way, won't ever turn away from anything gruesome... NEVER have I seen or read anything that affected me the way this story did... I felt like walls were spinning and closing in on me and I was shrinking in my seat. My mind just kept placing me into the picture, into her position. How sure she must have felt that it was just another binge and purge and that afterwards everything would be fine. What it must have felt like when it happened.
I've been crying and crying, can't stop, and going over this story over and over pretty much all night now... I think the fear of this story has pushed me to my edge and I DON'T EVER WANT TO STARVE OR BINGE AGAIN. I don't know if it's possible to get to a point where you can just stop all the sudden like that, but that's how I feel right now and it's all because of you and your blog.
Thank you SO MUCH for telling somehow the only story that's ever gotten through to me, and you have no idea what this means to me. I don't have the slightest clue where I go from here, but hopefully I can eventually find myself somewhere in the middle (instead of either at the top of Everest or in the darkest depths of hell). I will keep her picture and her story in the back of my mind for the rest of my life.
Oh, Lauren, I wish I could give you a big hug right now.
Thank you so much for sharing your story. It touched my heart.
There's a wonderful website called We Bite Back (http://www.webiteback.com/) There, in the forums, you will find many who have been stuggling like you who are receiving help from members there who have recovered from their EDs. The members know what you're going through and will help you on the road to recovery. Please take a moment to check out the site. I have referred many readers there who are suffering from EDs and they have told me the help they've received from the recovered members has made such a difference in their health and lives. And they've made many friends.
Please keep in touch and let me know how you're doing, Lauren. And thank you for your very kind words.
Thinking of you and sending positive, healing thoughts your way.
Hugs,
Medusa
xoxo
Thank you for sharing this story.. I'm so scared of this happening to me..how much is 5 litres of food,, I mean I can binge and have been binge/purging for years, and soon I'm seeing a specialist to help me recovery.
This story has reminded me that purging can actually make my stomach weaker and weaker.. you have made me want to recover so much more. Thank you so much.
Eileen, thanks so much for your very kind comments.
In answer to your question, 5.6 litres equals 6 quarts.
I wish you every success in your recovery.
Hugs,
Medusa
I didnt know so many things could happen to me. Your post has really made me think. I'm so scared now. I DONT To DIE that way!
I started out being diagnosed with anorexic. I had been struggling with that on and off since I was a teen. When I "got caught" I was watched by my parents (even though I'm 27) and had to report in to them and a really good friend of mine. I soon realized that I guess I needed to eat in front of them...but then I could "get rid of it"
I have since been dianosed with bulimia. I hate that word. HATE IT!
I dont binge I just "get rid" of everything that I eat. I hate that IT controls my life.
I will try harder and do the things my Doc and counselor has been wanting me to do.
Thanks for posting what you did. It tells the truth...and thats what I SO BADLY need.
i cant belive tha tragedy that happened 2 this poor girl i used 2 starve mself 2 tha point of collapse but now love bingin on chocolate and junk food went 2 tha anorexia clinic 2 day and still only weigh 40 kg and cant understand why this disease wont take me even though i will b leavin behind an 11 yr old son who i love 2 tha max but hate my life and cant cope with out my dear mum who passed away 3 yrs ago
(((Anonymous)))
My heart goes out to you. I wish you every success in recovering. Sending positive, healing thoughts your way.
Medusa
xoxo
babygirl171,
I can't get the picture out of my head of your 11-year-old son alone, crying over your coffin.
PLEASE get help. Your son needs his mom.
Medusa
Oh wow :|
I actually want to say thank you to you...? I am suffering with anorexia at the moment and have been on and off for 2 years now. I weigh 6 stone 4 and have a 25 inch waist.
I'm in therapy :( but this has REALLY scared me and has urged me forward into my recovery. Ana promises so much and so does Mia but they're so wrong and can suck you into nothing. THANK YOU SO SO SO MUCH...I REALLY THINK YOU JUST SAVED ME!!!!!!!!!!!!! xxxxxxxxx
(((Anonymous)))
Thanks so much for your kind words.
Sending positive, healing thoughts to you and best wishes on your road to recovery.
Medusa
xoxo
I'm a pretty big girl 5'3 (~155 lbs.) I don't suffer from an eating disorder... but I do have a tendencies to binge and purge and fast.... although I know I'm too big to even qualify for danger.... seeing posts like this only remind me of the dangers. I'm a psychology minor, I read on this stuff all the time...
What my point is, posts like this simply remind... but there's only so much those reminders can do. It can't scare someone into stopping. I can see how many people have fallen into either disorders.... it's scary, but I know I'm not going to stop.
When I think back to my darkest days, I shudder at the thought of how close I could have come to meeting am untimely death such as this. I am in no way healed from anorexia-bulimia. I think my greatest fear is that if I start to eat a normal amount of calories, that I'll put on weight - due to decreased stomach elimination that purging has no doubt caused. I feel out of control. Know of any support groups in SE QLD, Australia?
I'm so pleased I found you Medusa! This story rang so true it scared me. This could be me in the future. I've always known I was damaging my body,but not actually realised how much until I saw the graphic evidence. It's given me a reason to stop now, rather than putting it off till tomorrow or the next day. There's always an excuse. I'm stressed, tired, upset...
Katja, your story touched me as I know exactly where you are coming from with the whole 'badge of honour thing'. I too started with anorexia before the bulimia took over. I'm now what's percieved as a healthy weight BMI 20, but I'm the most out of control and messed up I've ever been but feel like I was better as an anorexic cos at least then I felt entitled to have an ED. I'm so pleased I found like minded people after 6 years of suffering alone and pushing away those closest to me.
Thank you all for your comments.
Nightshade, sending healing thoughts your way and wishing you every success on your road to recovery.
Hugs,
Medusa
Hi, I'm turning 17 in a month and have been battling with bulimia for 2 years. Last friday I lied to my mom and faked a stomach problem just so that she would take me to the emergency room. Then behind closed doors, I told the doctor I was bulimic and had just overdosed on pain killers (I took them to make me look more sick in order to make my mom believe me). Luckily, my tylenol level wasn't dangerously high, but I was in the ER for 6 hours and they said I was dehydrated. I left with a list of therapists I could contact.
Then about 6 hours after that, I did it again. And I was so sure that what had happened that morning was my wake up call (and the wake up call for my mom as well, she had always thought that this was something you could handle on your own, without outside help). I wanted those doctors to make her believe that I had a real problem and they did. But the moment I got her trust again, the moment I was left alone, I lied and I did what I couldn't stop myself from doing. The doctors had just told me that I had taken that huge first step towards recovery, and I didn't.
I'm hoping tonight was my last purge, it wasn't even worth it. I didn't eat anything and I didn't feel any better after. My face is swollen, I can see the veins in my hands, feet, and arms, and I hate tellign everyone that I got the calluses on the back of my hand by burning it on accident.
Plus, I've gained weight, which doesn't make anything better.
The thing is, I can't bear to think that I will be doing this in college, I told the doctor that, and I told myself that. I just can't do it anymore.
Anyways, I just wanted to take this opportunity to thank you for furthering my drive to help myself. I don't know how long it will take me, I knew this was going to be a problem from the moment I started. It was an obsession that turned into an addiction that turned into a way of life, and now I have to reverse everything and start anew. I want my life back and I thank you again for having open ears for the stories of those who are suffering from this disorder.
this is really scary..good thing that i am not a binger or anything like that.my throat got dry while reading this
I'm 41 and have been bulimic since the age of 16. It's a miracle I'm still alive. The pictures on your site are the first I've ever seen which directly show the physical damage.
I have the hand damage and suffer from palpatations along with occasional bleeding when vomiting.
None of this has ever deterred me. It's a bit like a smoker being told it will kill you, but the addiction has you in such a grip that you develop a deaf ear to it all.
Tonight that's changed for me. I made myself read through the autopsy report and look at the pictures..
There is no way on earth that I will allow my children, husband or parents to one day find me dead on the toilet floor.
Thank you for posting these images and the report. It may not work for everyone, but after 20 years of bulimia it has worked for me.
x
I'm 41 and have been bulimic since the age of 16. It's a miracle I'm still alive. The pictures on your site are the first I've ever seen which directly show the physical damage.
I have the hand damage and suffer from palpatations along with occasional bleeding when vomiting.
None of this has ever deterred me. It's a bit like a smoker being told it will kill you, but the addiction has you in such a grip that you develop a deaf ear to it all.
Tonight that's changed for me. I made myself read through the autopsy report and look at the pictures..
There is no way on earth that I will allow my children, husband or parents to one day find me dead on the toilet floor.
Thank you for posting these images and the report. It may not work for everyone, but after 20 years of bulimia it has worked for me.
x
iwillmakeit, thank you so much for sharing your story and your kind comments. Best wishes to you.
And, Sarah, my heart is breaking for you. I understand what an addiction purging is.
Wishing you every success in the world in beating this monster.
Hugs,
Medusa
I saw this site, while searching the internet. Sadly enough, I was looking for a way to lose weight, and fast. I thought purging, and binging would help me. I have been called fat, and ugly my entire life. I have a very supportive husband, who assures me that I am a beautiful woman. I just don't see it. I think I have an okay face, but my body is terrible. After seeing this, I think I'll continue eating the things I do, but maybe not quite as much. No matter how "fat" I get, I don't want to lose my life because of someone elses opinion.
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