Salehi Omar, Eqbal Ali
Context Acute necrotising pancreatitis is a potentially devastating gastrointestinal condition that has a fatality risk of up to 40% in hospitalised patients who develop multi-organ failure. Diagnostic criteria rely on characteristic abdominal pain, elevated serum lipase or amylase levels and radiological features on CT or MRI as per the revised 2012 Atlanta classification. Serum lipase is very useful in the diagnosis of acute pancreatitis with a high negative predictive value of 94-100%. Acute necrotising pancreatitis without an elevated serum lipase is rare, with only 3 cases reported in previous literature. Case We describe the case of a 64-year-old man who presented with idiopathic severe acute, necrotising pancreatitis without an elevation in serum lipase. Conclusion This case demonstrates the potential benefit of early abdominal imaging in patients presenting with classic clinical features of acute pancreatitis, despite a normal serum lipase
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