Rupture of the external iliac and bilateral femoral arteries in a patient with anorexia nervosa.

Background: Severe anorexia nervosa can result in life-threatening systemic complications. However, arterial rupture in the context of anorexia nervosa has not been reported.

Case report: A 31-year-old woman who had developed anorexia nervosa in her early teens and had extreme malnutrition with a body mass index of 8.5 kg/m² was admitted to our hospital with impaired consciousness due to hypoglycemia. During the management of hypoglycemia and refeeding syndrome, the patient developed hematochezia and shock. Contrast-enhanced computed tomography revealed rupture of the right external iliac and bilateral femoral arteries. Nonocclusive mesenteric ischemia was also detected. Surgical interventions for the ruptured arteries and the intestinal lesion were not indicated due to her poor condition with coagulopathy, as well as the presumed vascular fragility suggested by the presence of multiple arterial ruptures. The patient died later that day.

Conclusions: This case highlights a previously unreported and fatal vascular complication of anorexia nervosa. Extreme malnutrition may cause vascular fragility, increasing the risk of arterial rupture due to structural collapse of the vessel wall. Clinicians should be aware of this rare but life-threatening complication when treating patients with severe anorexia nervosa.

Level of evidence: Level V, case report.