Diagnostic dilemma: Speed eating a 7-pound burger sent a man to ER unable to pass gas

The patient: A 30-year-old man in Singapore

The symptoms: The patient visited the emergency room with a bloated stomach and gut pain.

What happened next: When doctors examined the man, they found his abdomen was swollen and distended. They ordered an X-ray but the scan did not reveal any air pockets in the patient's abdominal cavity, which can be a sign of bowel perforation.

Blood tests then showed that the man had elevated levels of immune cells, called white blood cells, in his circulatory system, and that levels of creatinine and amylase were also higher than normal. Creatinine is a waste chemical left over from energy production in muscles, and amylase is an enzyme that helps digest carbohydrates. An elevated white blood cell count can happen in response to infection, but disease or sudden stress can also cause white blood cells to multiply.

The doctors then ordered a computed tomography (CT) scan of the man's abdomen and pelvis, which showed that his stomach and the upper part of his small intestine were "grossly distended with food material," the doctors wrote in a report of the case. The man's intestines had been pushed over to the left side of his abdomen, flattening his pancreas.

The diagnosis: According to the patient, eight hours prior to visiting the emergency room, he had participated in a speed-eating competition. During the contest, he consumed a burger weighing 7 pounds (3.2 kilograms) in just 30 minutes. The man had vomited soon after, regurgitating undigested food but expelling no blood or bile. At the hospital, the doctors determined that the man's symptoms were caused by the sizable burger, which the patient had eaten too quickly for his stomach to digest.

The treatment: Doctors admitted the patient to the general ward of the hospital. They attempted to relieve the pressure in his stomach through a tube inserted in his nose, which could have helped the excess gas in the digestive tract escape. However, his abdomen remained distended, and the pain continued.

The doctors considered performing a gastrostomy — surgically opening the stomach through the abdominal wall — to remove the undigested food. However, the patient soon began passing gas, suggesting that his digestive system was starting to catch up and process the huge mass of chewed-up burger. Blood analysis showed that the man's white blood cell count was starting to return to normal. Finally, the patient had a bowel movement. Five days later, his symptoms had fully abated, and he was discharged.

What makes the case unique: When fully expanded, the average adult's stomach can comfortably hold up to 50 ounces (1.5 liters), though this varies between individuals. People who regularly compete in eating contests "train" their stomachs to contain more than this average by repeatedly and rapidly stretching the stomach walls "during their gobbling episodes," the doctors wrote in their report.

But frequently cramming their stomachs with enormous quantities of food carries serious health risks, the physicians warned. These risks may include injury to the stomach wall or weakening of muscles that move food into the lower intestine; pneumonia from inhaling food particles into the lungs; and in the long term, obesity, according to the report.