ROLE OF MDCT IN PATIENTS OF SUSPECTED ACUTE PANCREATITIS WITH LESS THAN THREE FOLD RISE IN SERUM LIPASE LEVEL

Dr. Hitesh Kumar*, Dr. Vijay Thakur, Dr. Sushma Makhaik, Dr. Sanjay Mahajan and Dr. Esha Singh

ABSTRACT

Background: Role of amylase and lipase in the diagnosis and prognosis of acute pancreatitis has frequently been the subject of confusion and controversy. A three fold rise in serum amylase and lipase is required for diagnosis of acute pancreatitis. However acute pancreatitis can occur with normal levels of amylase and lipase confirmed by computed tomography. Methods: In this study, total 40 patients were included who presented with clinical suspicion of acute pancreatitis. These patients were evaluated clinically, biochemical analysis was done and then CECT was done in all cases after 72 hours. CECT findings were evaluated in all the patients. Modified CT severity index was calculated in each patient and its correlation between serum amylase and lipase values was evaluated. CECT findings in lipase negative and lipase positive patients were compared. Patients were followed up for complications at two months interval. Results: 29.8% of the study population (Lip−) had less than three fold rise in serum lipase levels at presentation despite abdominal pain and signs of Acute pancreatitis on CECT. Extra-pancreatic findings such as pleural effusion and Ascites were more in lipase positive patients. On follow up, complications were significantly more in lipase positive group as compared to lipase negative group (19.2% vs 9.1%). Conclusion: A significant subset of patients with clinically suspected acute pancreatitis, without threefold increase in lipase levels on admission can also have evidence of acute pancreatitis on imaging. Without CECT, this substantial subset of patients would remain under-diagnosed. CECT is absolutely mandatory in subset of patients with less than three fold rise in serum lipase for correct early diagnosis of acute pancreatitis and thereby reducing mortality and morbidity.

Keywords: MDCT; Acute pancreatitis; serum lipase; less than three fold rise.