A rare entity in ED: Normal lipase level in acute pancreatitis.

Acute pancreatitis can have a variable presentation and diagnosis is based on clinical presentation, serum amylase and lipase levels and computed tomography. Negative predictive value of serum lipase in diagnosing acute pancreatitis is approximately to 100 percent and a normal blood lipase level in acute pancreatitis is an extremely rare condition. Here we reported two cases with normal serum amylase and lipase levels.

Recognizing acute appendicitis criteria on abdominal CT: do emergency physicians need a preliminary report?

BACKGROUND: Computed tomography (CT) is invaluable for the diagnosis of acute appendicitis (AA) in the emergency setting when used appropriately with proper risk stratification. The aim of this study is to investigate the capability and accuracy of emergency physicians (EPs) at recognizing AA criteria in intravenous contrast-enhanced abdominal CT and to investigate the level of interobserver agreement among them. METHODS: Consecutive patients who presented to Izmir University Hospital from January 1, 2014, to December 31, 2014, were evaluated. Patients with histopathologically confirmed AA and had intravenous contrast-enhanced abdominal CT were enrolled. Abdominal CT were interpreted by 4 EPs in a blind fashion. To compare differences in performances between observers, sensitivity, specificity, positive predictive value, negative predictive value, and κ values were calculated. The results were then compared with the radiology department's official reports. RESULTS: There were 48 patients eligible for the study. Among these patients, 19 were male (41%), with a mean age of 34.4 years (±11.3 years). Five patients were CT-negative appendicitis according to official radiology reports that were accepted as the criterion standard. The best sensitivity and negative predictive values were achieved at criterion "enlargement of the appendix," whereas the least sensitivity was for criterion "lack of opacification in an enlarged appendix." CONCLUSIONS: The recognition of the CT criteria for AA among EPs is substantial at best, and their ability to recognize the primary criteria for diagnosing AA is good. Emergency physicians have to gain a higher level of expertise to use this invaluable diagnostic tool more efficiently.

Acute pancreatitis due to extracorporeal shock wave lithotripsy: a rare complication.

Extracorporeal shock wave lithotripsy (ESWL) is considered the treatment of choice for most renal and upper ureteral stones. Although extensive data have documented its safety, serious complications have been reported in 1% of patients, including acute pancreatitis, perirenal hematoma, urosepsis, venous thrombosis, biliary obstruction, bowel perforation, lung injury, and rupture of aortic aneurysms. Here, we report a 41-year-old woman who underwent ESWL for a calculus at the right renal pelvis and immediately developed acute pancreatitis after the procedure. Although the possibility of post-ESWL acute pancreatitisis extremely low, physicians must be aware of this complication in emergency departments.