COVID-19 and Serum Amylase and Lipase Levels.

Blood levels of amylase and lipase are the result of a balance between production and clearance of these enzymes. Normal blood level of amylase and lipase is 0-90 U/L and 0-70 U/L, respectively. Rise in blood levels of lipase and amylase was observed in pancreatic injury. This is an observational, cross-sectional study involving 279 patients [176 COVID-positive and 103 COVID-negative] admitted at a tertiary care hospital in Mumbai during COVID pandemic. The mean age was 45 years with SD of 15 years with men:women ratio of 2.7:1. Serum lipase and amylase were raised in 101 cases (57.4%) and 57 patients (32.4%), respectively. Out of the 101 patients with raised lipase levels, 44 (25%) patients showed a severe rise (> 3 times the normal), and out of 57 patients with raised amylase levels, 12 patients (6.8%) showed a severe rise (> 3 times the normal). From this study, it can be concluded that the prevalence of hyperamylasemia was 32.4% and that of hyperlipasemia was 57.4% in the involved study population with COVID-positive status.

De novo Choledocholithiasis in Retained Common Bile Duct Stent.

De novo choledocholithiasis means formation of stone in the common bile duct (CBD). It can present as biliary colic, jaundice, cholangitis, pancreatitis or it may be asymptomatic. There are various indications for biliary stenting like CBD stone, CBD stricture, biliary leak, peri ampullary carcinoma, CBD malignancy, etc. Foreign bodies like silk sutures, endo-clips, fish bone, retained T- tubes, plastic or metallic stents, etc. lead to biliary stasis leading to eventual stone formation. Here, we discuss a case of choledocholithiasis post-cholecystectomy with CBD stenting done 15 years back which had migrated and acted as a nidus for stone formation in the CBD and hepatic duct.

A Large Cystic Variant of Gastro-intestinal Stromal Tumour arising from the Jejunum: A Case Report.

Gastrointestinal stromal tumours (GISTs) represent a mesenchymal neoplasm arising from the interstitial cells of cajal occurring mainly in the gastrointestinal tract. Here, we present a case of a large GIST arising from the jejunum with cystic presentation unlike the usual presentation as a solid mass. A 50-year-old male patient came with complaint of a painless mobile lump in abdomen of approximately 25 cm in size which had gradually increased over two years. Clinically mesenteric cyst was suspected. Intra-operatively the mass was a 30x25 cm cyst with approximately 2500 ml serous fluid present inside it arising from the anti-mesenteric border of the jejunum, adherent to the jejunum, appendix and the dome of the bladder. The fluid was aspirated and the mass excised along with resection of the involved jejunal segment and appendectomy was done. Diagnosis was confirmed on immunohistochemistry study. Imatinib Mesylate 400 mg OD was started as adjuvant therapy in view of the high risk of metastasis.