Atypical Presentation of Acute Pancreatitis: Case Report and Review of Literature

Background: Acute pancreatitis is a common inflammatory disorder of the pancreas, typically presenting with sudden upper abdominal pain, nausea, and vomiting. Despite its well-documented classic presentation, atypical manifestations can lead to initial misdiagnosis and complicate the clinical course. Case Presentation: A 42-year-old female presented to the emergency department with left flank pain and watery diarrhea, initially treated as gastroenteritis or renal colic. Despite treatment with NSAIDS (ketorolac) and intravenous fluids, her pain persisted and worsened. Laboratory tests revealed an elevated white blood cell count (23x10(3)/mu L), normal pH and electrolytes, and a CRP of 7 mg/dL. Serum lipase was significantly elevated (>3000 U/L), and ultrasound imaging showed a bulky head and body of the pancreas with minimal peripancreatic fluid, confirming the diagnosis of acute pancreatitis. MRCP performed on day 4 revealed acute interstitial pancreatitis with focal changes in the body of the pancreas and minimal pancreatic fluid. The patient was managed conservatively and discharged on day 9. Discussion: This case illustrates an atypical presentation of acute pancreatitis with flank pain and diarrhea, emphasizing the need for high clinical suspicion and thorough diagnostic evaluation. Acute pancreatitis can present with a wide range of symptoms, complicating timely diagnosis and management. While elevated serum lipase and characteristic imaging findings are diagnostic, atypical presentations may delay appropriate treatment. The patient's condition improved with conservative management, underscoring the importance of recognizing and managing atypical presentations of this condition. Conclusion: This case highlights the diverse clinical manifestations of acute pancreatitis and the importance of considering this diagnosis even in the absence of typical symptoms. Increased awareness and further research are needed to understand the full spectrum of atypical presentations, ensuring prompt and accurate diagnosis and management.