# A rare convergence: Gangrenous bowel secondary to closed-loop obstruction with elevated urine amylase levels - A comprehensive case report

## TL;DR

A young woman with high urine amylase levels was initially thought to have pancreatitis but was later found to have gangrenous bowel due to a closed-loop obstruction.

## Contribution

Highlights a rare case where elevated urine amylase levels were caused by bowel obstruction, not pancreatitis.

## Key findings

- Urine amylase levels can be elevated in non-pancreatic conditions like bowel obstruction.
- CT imaging was crucial in diagnosing the true cause of the patient's symptoms.
- Conservative management failed, necessitating emergency surgery for gangrenous bowel.

## Abstract

Urine amylase levels are usually used to diagnose acute pancreatitis. However, there are reported cases where urine amylase levels are slightly increased in individuals without pancreatitis. Herein, we report the case of a young lady who presented with acute abdominal pain for 3 days. Her urine amylase level was 1717 U/L upon admission, and her condition was initially treated as acute pancreatitis. Unfortunately, the patient demonstrated abdominal guarding after 24 h; thus, urgent computed tomography (CT) was performed. CT revealed the presence of a dilated small bowel. She underwent emergency laparotomy, wherein a gangrenous small bowel with no evidence of saponification at the lesser sac was noted. Due to the non-specific nature of hyperamylasaemia, an alternative diagnosis other than acute pancreatitis should be considered if the clinical symptoms are not suggestive of pancreatitis or the condition worsens despite conservative management.