CASE DESCRIPTION/METHODS: A 31-year-old transgender female presented to the hospital with epigastric pain, fever, chills and decreased appetite. Laboratory work-up was significant for lipase .7,500 u/L, triglycerides .7,000 mg/dL and calcium of ,4 mg/dL. The patient denied alcohol use, diabetes, hypothyroidism or family history of pancreatitis. Initial management included ag- gressive intravenous fluid resuscitation. CT scan of the abdomen was performed and was notable for a large peripancreatic fluid collection most consistent with walled off necrosis (Figures 1 and 2). Three retroperitoneal drains were placed into the fluid collections with clinical improvement. Upon further questioning, it was discovered that several months prior to admission, the patient had started taking oral estrogen therapy obtained via an online store to transition from male to female, which was ultimately felt to be the most likely cause of her very severe hypertriglyceridemia. Two weeks after discharge, patient had IR drain exchange and repeat CT scan showed almost complete resolution of the fluid collections and her drains were removed. DISCUSSION: Medications are often described as the etiology for why people develop pancreatitis. However, to clearly prove a medication as the inciting factor, reinitiation of that medication needs to occur in order to establish a temporal relationship. Estrogen is a rare cause of drug-induced pancreatitis with approximately 40 cases reported worldwide. It is one of the few medications that has a described mechanism, hypertriglyceridemia, for the development of pancreatitis. Of the 40 cases described only 2 published case reports involve transgender females (7) (Table 1). The number of transgender patients presenting to the healthcare system for care is growing (9.2 per 100 000). Importantly, transgender females require supraphysiologic doses of estrogen therapy to maintain secondary sexual character- istics. Accounting for these factors, it is important for healthcare providers to understand their risk for and ways to prevent acute pancreatitis from occurring in their transgender patient population (8). 1412 A Rare Case of Post-ERCP Panniculitis Lindsey C. Shipley, MD, Timothy A. McGraw, MD, Charles A. Parrish, MD, Devin S. Harrison, FNP, Rachel E. Mitchell, FNP, Charles M. Wilcox, MD, MSPH, Ali M. Ahmed, MD. University of Alabama at Birmingham, Birmingham, AL. INTRODUCTION: Pancreatic panniculitis affects 0.3-3% of patients with a wide variety of pancreatic disorders. It is characterized by subcutaneous fat necrosis following the release of pancreatic enzymes into the circulation. Endoscopic retrograde cholangiopancreatography (ERCP) is a rare cause of panniculitis. Based on our literature review, this is the fourth case report of post-ERCP panniculitis. CASE DESCRIPTION/METHODS: An 80-year-old female with a history of choledocholithiasis with biliary stent placement presented for elective ERCP. The procedure demonstrated a moderate, inflammatory distal biliary stricture, a migrated biliary stent and choledocholithiasis. A biliary sphincterotomy, cholangioscopy and laser lithotripsy and stent exchange was performed with ap- proximately 80% of stone removal. Post- procedure the patient noted tender erythematous raised nodules on her legs. Skin biopsy was performed with findings consistent with pancreatic pannicultitis. Follow-up ERCP was normal with trace sludge and removal of the biliary stent. At follow-up she was improved without abdominal pain and reported healing of the lower extremity cutaneous lesions. DISCUSSION: Pancreatic panniculitis is a rare skin finding that is independent of disease severity and can occur at any point during the disease process. Post-ERCP panniculitis is rare and only reported in three other cases. Pancreatic panniculitis is typically tender, ill-defined, red-brown nodules located in the lower extremities. The gold standard for diagnosis is biopsy with histopa- thology significant for a mostly lobular panniculitis without vasculitis with the presence of the typical ghost cells, necrotic and calcified adipocytes. Treatment is aimed at addressing the underlying pancreatic disease and the lesions typically resolve with improvement in pancreatic inflammation. 1413 Twelve-Year-Old Male With Esophageal Dysphagia: A Diagnostic Dilemma! Lindsey C. Shipley, MD, Saurabh Talathi, MD, John T. Wilson, BS, Ali M. Ahmed, MD, Neelesh Tipnis, MD. University of Alabama at Birmingham, Birmingham, AL. INTRODUCTION: Esophageal dysphagia is defined as any difficulty or abnormality of swallowing with delay in transit of solids or liquids in the esophageal phase. We present an interesting case of a young male evaluated for esophageal dysphagia and failure to thrive who was, after an extensive workup, found to have an esophageal duplication cyst. CASE DESCRIPTION/METHODS: A 12-year-old male was transferred from a local hospital with a 4-week history of sub-sternal pain, worsening dysphagia, odynophagia, a sensation of “food stuck in his chest” and an 8-pound weight loss. He was seen by his primary physician and started on ranitidine for possible gastrointestinal reflux disease (GERD) without improvement in his symptoms. He was admitted a week later due to worsening symptoms, new onset nausea, non-bloody, non- bilious vomiting and a fever (102.5 F). Due to persistent symptoms, an upper gastrointestinal series with contrast was performed, which was concerning for an esophageal diverticulum, an esophageal manometry and ultimately, esophagogastroduodenoscopy (EGD). An EGD revealed congested and friable mucosa throughout the esophagus, and a large opening in the posterior aspect of the middle esophagus. Due to inability to intubate this opening with a regular size endoscope, a neonatal upper endoscope was used. The opening was intubated, and the esophageal cyst was visualized (Video 1). [1410] Figure 3. Common hepatic duct biopsy. Hematoxylin and eosin stain (left): benign biliary epithelium and scant fibrous fragments, fibrin and blood. Immunostain for HHV-8 (right): few endothelial cell nuclei are immunoreactive. [1411] Figure 1. CT scan of the abdomen notable for a large peripancreatic fluid collection most consistent with walled off necrosis. [1411] Figure 2. CT scan of the abdomen notable for a large peripancreatic fluid collection most consistent with walled off necrosis. [1410] Figure 2. ERCP: Common hepatic duct with a stricture 3 cm in length. © 2019 by The American College of Gastroenterology The American Journal of GASTROENTEROLOGY Abstracts S783 Copyright © 2019 by The American College of Gastroenterology. Unauthorized reproduction of this article is prohibited.