Summary of case reports of pancreatitis in AN
| Source | Year | BMI if stated (kg/m2) | No of AN cases | Evidence of pancreatitis | Comments |
| Gwee80 | 2010 | 16.4 | 1 | Abdominal pain, distension and vomiting. AXR: gastric distension. Barium meal distended stomach and duodenal obstruction. Day 3 lipase 1801 units/L and amylase 473 units/L. CT diagnosed SMA syndrome. MRCP reported gallstones (<5 mm no duct dilatation) and narrowed distance between SMA, SMV and aorta suggestive of SMA syndrome. | Microlithiasis was reported as likely explanation. |
| Morris, 81 | 2004 | 20.8 | 1 | Abdominal pain, nausea and vomiting Abnormal CT (features of acute pancreatitis). Follow-up MRCP reported no biliary disease. USS: no sludge or gallstones. Admission amylase 50 IU/L) and Lipase 399 IU/L day 3 lipase 944 IU/L and amylase 64 IU/L Patient underwent cholecystectomy. Intraoperative cholangiogram and gallbladder histology were normal. No sludge or microlithiasis. No further episodes at 6 months. | Severe malnutrition or anorexia resulting in deranged pancreatic pathology/physiology Patient was taking sertraline 50mg >5 years without side effects and not felt to be the cause in this case |
| Backett, 82 | 1985 | 11.96 | 1 | Day 15 of admission: abdominal pain, nausea and vomiting Amylase 1535 U/L AXR: dilatation of stomach and duodenal cap | Refeeding causing gastric dilatation and duodenal ileus causing rise in duodenal pressure and reflux into pancreatic duct resulting in inflammation. |
| Cox 18 | 1983 | n/a | 10 | 6/10 patients had abdominal pain and/or nausea and/or vomiting. Of these six patients three had positive USS confirmation of pancreatitis (reduced echogenicity) 3/10 had serum amylase values greater than 90 units/L | Changes may be secondary to malnutrition. Theories included: acinar atrophy, reduced zymogen granules, epithelial metaplasia, cystic dilation of ducts and fibrosis. |
| Keane, 58 | 1978 | n/a | 1 | Day 5 of admission developed abdominal pain, nausea and vomiting. Amylase 885 IU/L. AXR: gross distention of stomach and proximal duodenal dilatation. Laparotomy confirmed acute pancreatitis and peritoneal fluid amylase was 4600 IU/L. | Refeeding compounds an SMA syndrome leading to duodenal ileus and gastric dilatation leading to retrograde pressure forcing duodenal contents into pancreatic duct |
AN, anorexia nervosa; AXR, abdominal X-ray; BMI, body mass index; CT, computed tomography; MRCP, magnetic resonance cholangiopancreatography; n/a, not applicable; SMA, superior mesenteric artery; SMV, superior mesenteric vein; USS, ultrasound scan.