Normal lipase acute pancreatitis: A case report and brief review of literature

Submitted: 10 August 2022
Accepted: 18 November 2022
Published: 20 December 2022
Abstract Views: 804
PDF: 257
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Acute pancreatitis is a common presentation in Emergency Department. Elevated amylase and lipase level are one of the three important criteria to diagnose acute pancreatitis. Out of amylase and lipase, the latter is considered more specific for acute pancreatitis. We report a case of acute pancreatitis with a normal lipase level. On review of published literature on acute pancreatitis with normal lipase levels, 23 such case reports were retrieved. A brief review of all these cases including the case presented here had unknown etiology in 50% of cases followed by alcohol and gall stone. Pain abdomen was the commonest presentation followed by vomiting. The normal discharge could be done in 71% of cases and 17% of patients were non-survivors. Hence, normal lipase cannot rule out acute pancreatitis on its own. A typical presentation of acute pancreatitis needs radiological work up like an Ultrasound abdomen or CT scan with IV contrast (if not contraindicated) before refuting its possibility.

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Citations

Mederos MA, Reber HA, Girgis MD. Acute pancreatitis: a review. JAMA 2021;325:382-90. DOI: https://doi.org/10.1001/jama.2020.20317
Yadav D, Agarwal N, Pitchumoni CS. A critical evaluation of laboratory tests in acute pancreatitis. Am J Gastroenterol 2002;97:1309-18. DOI: https://doi.org/10.1111/j.1572-0241.2002.05766.x
Frank B, Gottlieb K. Amylase normal, lipase elevated: is it pancreatitis? A case series and review of the literature. Am J Gastroenterol 1999;94:463-9. DOI: https://doi.org/10.1111/j.1572-0241.1999.878_g.x
Cartier T, Sogni P, Perruche F, et al. Normal lipase serum level in acute pancreatitis: a case report. Emerg Med J 2006;23:701-2. DOI: https://doi.org/10.1136/emj.2006.037655
Shah AM, Eddi R, Kothari ST, et al. Acute pancreatitis with normal serum lipase: a case series. J Pancreas 2010;11:369-72.
Agrawal A, Parikh M, Thella K, Jasdanwala S. Acute pancreatitis with normal lipase and amylase: an ED dilemma. Ame J Emerg Med 2016;34:2254-e3. DOI: https://doi.org/10.1016/j.ajem.2016.05.023
Limon O, Sahin E, Kantar FU, et al. A rare entity in ED: Normal lipase level in acute pancreatitis. Turkish J Emerg Med 2016;16:32-4. DOI: https://doi.org/10.1016/j.tjem.2014.09.001
Mathur AK, Whitaker A, Kolli H, Nguyen T. Acute pancreatitis with normal serum lipase and amylase: A rare presentation. J Pancreas 2016;17:98-101.
Yang L, Zhao Z, Zhou K, Zhang Y. Acute hyperlipidemic pancreatitis accompanied by chylous ascites with normal amylase and lipase in pregnancy. J Clin Lipidol 2017;11:1091-4. DOI: https://doi.org/10.1016/j.jacl.2017.06.002
Sharma A, Masood U, Khan B, Chawla K, Manocha D. Pancreatitis with normal lipase and amylase in setting of end-stage renal disease. Am J Emerg Med 2017;35:1387-e3. DOI: https://doi.org/10.1016/j.ajem.2017.07.014
Nadhem O, Salh O. Acute pancreatitis: An atypical presentation. Case Reports Gastroenterol 2017;11:359-63. DOI: https://doi.org/10.1159/000475920
Mungan Z, Attila T, Kabaoğlu ZÜ, Vural M. Vildagliptin-induced acute pancreatitis without enzyme elevation. Turk J Gastroenterol 2017;28:514-7. DOI: https://doi.org/10.5152/tjg.2017.17308
Wang YY, Qian ZY, Jin WW, et al. Acute pancreatitis with abdominal bloating and distension, normal lipase and amylase: a case report. Med 2019;98:e15138 DOI: https://doi.org/10.1097/MD.0000000000015138
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, Tsiotos GG, Vege SS. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut 2013;62:102-11. DOI: https://doi.org/10.1136/gutjnl-2012-302779
Huang QL, Qian ZX, Li H. A comparative study of the urinary trypsinogen-2, trypsinogen activation peptide, and the computed tomography severity index as early predictors of the severity of acute pancreatitis. Hepato-gastroenterology 2010;57:1295-9.

How to Cite

Sanjeev, O. P., Singh, R. K., & Ghatak, T. (2022). Normal lipase acute pancreatitis: A case report and brief review of literature. Emergency Care Journal, 18(4). https://doi.org/10.4081/ecj.2022.10788