A Rare Case: Gall Stone Induced Acute Pancreatitis with Normal Amylase and Lipase Levels

Arindam Mukherjee,Govind Madhav,Ajay Tadha

doi:10.47008/ajs/2020.3.2.3

Abstract

Acute pancreatitis (AP) is most commonly diagnosed by increased values of serum amylase and lipase. Acute pancreatitis where value of serum amylase and lipase is normal is very rare. This is a case of gall stone induced AP where levels of serum amylase and lipase are normal but the clinical suspicion and imaging are strongly confirming pancreatitis.

Highlights

Patient presenting with severe upper abdominal pain with high clinical suspicion of acute pancreatitis is confirmed with raised values of serum amylase and lipase
Lipase estimation has better sensitivity and specificity than amylase, but it has been rarely reported to be present in normal values in confirmed cases of acute pancreatitis. [1,2,3,4,5] The revised Atlanta classification of acute pancreatitis came in 2012, it states that two of the following three features are required to confirm a diagnosis of acute pancreatitis: pain abdomen where in there is an acute onset of a severe epigastric pain, which is persistent and radiating to the back; serum lipase or amylase values are three times higher than their normal; or evidence of inflammation of pancreas on CECT, MRI or trans-abdominal ultrasonography
[4] Unlike serum amylase, serum lipase is reabsorbed by the kidney tubules, its value remains elevated for a longer period thereby facilitating its detection for longer duration in subset of patients who present late

Summary

Introduction

Patient presenting with severe upper abdominal pain with high clinical suspicion of acute pancreatitis is confirmed with raised values of serum amylase and lipase. Lipase estimation has better sensitivity and specificity than amylase, but it has been rarely reported to be present in normal values in confirmed cases of acute pancreatitis. We are reporting a case of 60 years lady with clinical picture of AP with normal values of serum amylase and lipase, but having signs of pancreatic inflammation on MRI. A clinical diagnosis of acute pancreatitis with left sided reactive pleural effusion with shock was arrived at, and her management was initiated on conservative line. Her total leucocyte count was 15,100/ mm.

Discussion

Conclusion