Serum Lipase Levels Carry Prognostic Value in Small Bowel Obstruction

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Introduction: In small bowel obstruction (SBO), there is an interruption in the passage of intestinal contents through the gut lumen. Case reports have described elevated pancreatic enzymes in patients with small bowel obstruction initially misdiagnosed as having pancreatitis. To our knowledge, there is no study which systematically addresses the issue or the prognostic value of elevated serum lipase in SBO.Table: Table. Patients' Baseline Characteristics (n=344)Methods: Patients with SBO and at least one serum lipase level identified between September 2013 and September 2016 were evaluated. Demographic, laboratory and imaging information; need for surgery or intensive care unit and mortality were evaluated. Results: Of 344 patients, 38 (11%) had elevated serum lipase levels. Patients with radiographic diagnosis of pancreatitis were excluded. Patients with elevated lipase had significantly higher levels of creatinine and lactic acid levels, length of stay, need for intensive care monitoring and death than patients with normal lipase levels. The need for surgical intervention was not significantly different between the two groups.Table: Table. Comparison of Patients with SBO and Normal or Elevated Serum LipaseConclusion: Small bowel obstruction should be considered in the differential diagnosis for elevated serum lipase levels. Abdominal computed tomography constitutes a useful resource to differentiate SBO from acute pancreatitis. In SBO, elevated serum lipase is a risk factor for higher serum creatinine and lactate, use of ICU, and mortality.

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