Introduction

Interpretation of abnormally high serum amylase activity is not always straightforward. Sometimes, as here, patients are erroneously labelled as having pancreatitis despite the absence of clinical features to support this diagnosis. Such assumptions may affect the interpretation of investigations.

Case report

A 53 year old woman was admitted to hospital, initially with a dense hemiparesis and dysarthria because of a left middle cerebral infarct. At the time of admission, she was recovering from a recent myocardial infarction. She was not known to be diabetic.

About six weeks after admission she complained of several episodes of vomiting. Routine haematology and biochemistry investigations were unremarkable apart from serum amylase activity of 1730 U/l (reference interval 0-100 U/l). This result immediately prompted surgical review. The surgical senior house officer diagnosed acute pancreatitis. A few days later the surgical registrar confirmed this clinical impression, although, in the complete absence of abdominal pain, the pancreatitis was described as mild. Multiple repeated measurements of serum amylase activity confirmed a rising trend, reaching as high as 5791 U/l. Abdominal ultrasound examination did not reveal any abnormality, although the pelvic region …