Table 3

Summary of case reports of pancreatitis in AN

SourceYearBMI if stated (kg/m2)No of AN casesEvidence of pancreatitisComments
Gwee80 201016.41Abdominal 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 200420.81Abdominal 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 198511.961Day 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.
1983n/a106/10 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.
1978n/a1Day 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.