A misunderstood intestinal perforation believed acute pancreatitis: a case report

Acute pancreatitis represents one, possible but rare, of the several complications of laparoscopic cholecystectomy. In the case reported, a 31-year-old female patient complained of abdominal pain after laparoscopic cholecystectomy. The clinical picture, the high values of serum amylase, lipase and white blood cell count and the subsequent abdominal computed tomography (CT) led to diagnose an acute biliary pancreatitis. This was pharmacologically treated, but the patient worsened in a few days. A contrastenhanced CT showed the presence of free air and effusion into the peritoneal cavity. The patient was submitted to another intervention, which revealed a 1-cm jejunal perforation. The injured loop was then repaired and the patient discharged after three days. The cause remains obscure but it was likely due to umbilical trocar insertion. An upper quadrant abdominal pain with elevated amylase and lipase serum concentration, not always indicate the presence of an acute pancreatitis but could be associated to a difficult case of intestinal perforation.