S3515 A Rare Case of Anorexia Nervosa Leading to Gallstone Pancreatitis

Introduction: Pancreatitis, which can present as either acute or chronic, is associated with a wide range of etiologies, including gallstones, alcohol use, medications, and anorexia nervosa (AN). AN is a disorder characterized by severe restriction of food intake, an intense fear of weight gain, and a distorted body image. It has been linked to various gastrointestinal complications, including pancreatitis, gastroparesis, gallbladder dyskinesia, and constipation. The association between pancreatitis and AN has been reviewed in the literature, with several proposed mechanisms, including gastric dilatation and dietary chaos syndrome. We present the case of a 26-year-old woman with AN who developed acute gallstone pancreatitis. Case Description/Methods: A 26-year-old woman with a history of anorexia nervosa (AN) and idiopathic gastroparesis requiring jejunostomy-gastrostomy tube (GJT) placement presented with acute diffuse abdominal pain and nausea. Physical examination revealed diffuse abdominal tenderness with guarding and minimal erythema around the GJT site. Laboratory tests showed elevated lipase (>6,000 U/L), white blood cell count (15.9 × 103/μL), AST (508 U/L), and ALT (365 U/L). Computed tomography imaging indicated acute pancreatitis, multiple gallstones, mild common bile duct (CBD) dilation, and moderate ascites with peritoneal thickening and hyperenhancement suggestive of peritonitis. Paracentesis confirmed secondary peritonitis, likely due to severe pancreatitis. The patient was managed conservatively with isotonic fluids and broad-spectrum antibiotics. Endoscopic retrograde cholangiopancreatography (ERCP) revealed a slightly erythematous major papilla and multiple filling defects in the CBD, consistent with small stones. The patient’s condition improved, and enteral feeding was initiated and advanced as tolerated. She was discharged with instructions to follow up with surgery for cholecystectomy, which she successfully underwent without recurrence of pancreatitis. Discussion: Pancreatitis and anorexia nervosa are complex conditions that can result in significant morbidity and mortality. While gastric dilatation and dietary chaos syndrome are recognized complications of anorexia nervosa, gallstone formation remains an underappreciated contributor to pancreatitis in this population. Malnutrition, rapid weight loss, and altered bile composition increase the risk of gallstone formation, potentially leading to acute pancreatitis. This case highlights the importance of considering gallstone pancreatitis in patients with anorexia nervosa.