Purpose or Case Report: Anorexia nervosa is a condition with a wide range of presenting signs and symptoms. Our report describes an adolescent suffering from restrictive anorexia nervosa (no purging) who presented with a Body Mass Index (BMI) of 9,73 kg/m² and asymptomatic spontaneous subcutaneous emphysema, pneumomediastinum, pneumoperitoneum and pneumatosis intestinalis. History revealed fatigue, lower limbs weakness, jaw pain and swollen neck over the last few weeks but no abdominal complaints. She was successfully managed with supportive care and progressive enteral nutrition leading to a favourable outcome with significant weight gain (BMI of 12,1 kg/m² at discharge). Her clinical course was complicated by refeeding syndrome and Rotavirus gastro-enteritis leading to a pre-shock state. We hypothesize that her clinical presentation was attributable to severe chronic undernourishment. Previous reports support the theory that severe undernourishment can lead to altered interstitial wall composition, which could result in migration of air through weakened alveolar or intestinal wall. This case is of interest given that spontaneous pneumoperitoneum and pneumatosis intestinalis have rarely been described in association with anorexia nervosa, especially in an asymptomatic patient. In addition, her favorable outcome suggests that these patients can effectively be managed with conservative care.
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