Upper Gastrointestinal Bleeding in a Young Woman with Eating Disorder History

Case at a Glance

A 22-year-old female with a 3-year history of anorexia nervosa and recent onset of self-induced vomiting presented with coffee-ground emesis, indicating upper gastrointestinal bleeding requiring immediate medical attention.

Patient's Story

The patient had been struggling with anorexia nervosa for approximately 3 years. Over the past 6 months, she had developed purging behaviors, specifically self-induced vomiting after eating. She had a previous hospitalization 6 months prior related to her eating disorder, which she described as traumatic. On the night of presentation, she noticed her vomit had a distinctive black, coffee-ground appearance, which caused significant anxiety. Despite recognizing this as potentially concerning, she was reluctant to seek medical care due to fear of psychiatric readmission.

Initial Assessment

The patient presented with hematemesis characterized by coffee-ground appearance, consistent with upper gastrointestinal bleeding. She had a significant psychiatric history of anorexia nervosa with recent development of bulimia nervosa behaviors. Physical examination and initial workup would be indicated to assess for signs of active bleeding, hemodynamic stability, and complications related to chronic malnutrition and purging behaviors.

The Diagnostic Journey

The black, coffee-ground appearance of the vomitus strongly suggested upper gastrointestinal bleeding with digested blood. Given the patient's history of frequent self-induced vomiting, differential diagnoses would include esophageal tears (Mallory-Weiss tear or Boerhaave syndrome), esophagitis, gastric ulceration, or other upper GI pathology. The chronicity of her eating disorder and malnutrition likely contributed to mucosal vulnerability and increased bleeding risk.

Final Diagnosis

Upper gastrointestinal bleeding secondary to complications from chronic purging behavior in the context of bulimia nervosa, likely involving esophageal or gastric mucosal injury.

Treatment Plan

Immediate emergency department evaluation for hemodynamic assessment, complete blood count, comprehensive metabolic panel, and coagulation studies. Upper endoscopy would be indicated to identify and potentially treat the bleeding source. Supportive care including IV fluid resuscitation, blood products if indicated, and proton pump inhibitor therapy. Psychiatric consultation for eating disorder management and coordination of appropriate level of care for both medical stabilization and eating disorder treatment.

Outcome and Follow-up

The case emphasizes the critical importance of immediate medical attention for gastrointestinal bleeding complications in eating disorder patients. Long-term management would require integrated medical and psychiatric care addressing both the acute bleeding episode and the underlying eating disorder to prevent future complications and promote recovery.