Recurrent Acute Pancreatitis in Anorexia and Bulimia

Context :Mild pancreatitis has been reported as a consequence of anorexia nervosa, bulimia nervosa, or what has been termed the “dietary chaos syndrome”. Either chronic malnutrition, or refeeding after periods of malnutrition, may precipitate acute pancreatitis through several pathogenetic mechanisms. Case report :A 26-year-old woman with a ten-year history of anorexia and bulimia presented with a third episode of acute pancreatitis in three months. The patient had been abstinent from alcohol for many years. Imaging studies during all three admissions failed to identify any biliary disease, including gallstones or biliary sludge. A cholecystectomy was performed, with a normal intraoperative cholangiogram, and no abnormalities on pathologic examination of the gallbladder and bile. The patient was discharged on hospital day 10 with no pain, and she has begun to return to regular eating habits. Pancreatitis has not recurred after 6 months of follow up. We have  identified 14 cases in the literature of acute pancreatitis associated with anorexia or bulimia. Conclusion :In the absence of evidence for gallstone, alcohol or metabolic etiologies, eating disorders may contribute to the pathophysiology of some idiopathic cases of pancreatitis.

Author(s): Luc G Morris, Jennifer L Marti, Kathryn E Stephenson, Sharon Herring

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