HighlightsBowel ischemia and necrosis is an uncommon complication of anorexia nervosa.We present a case of a 30 year old woman with long-standing AN complicated by ischemia and necrosis of the entire small bowel and the right hemicolon.A high index of suspicion of bowel ischemia is necessary when patients with AN present with abdominal symptoms.Timely diagnosis and treatment may prevent bowel necrosis and death.