A RARE CONVERGENCE: GANGRENOUS BOWEL SECONDARY TO CLOSED-LOOP OBSTRUCTION WITH ELEVATED URINE AMYLASE LEVELS – A COMPREHENSIVE CASE REPORT Urine amylase levels are usually used to diagnose acute pancreatitis. However, there are reported cases where urine amylase levels are slightly increased in individuals without pancreatitis. Herein, we report the case of a young lady who presented with acute abdominal pain for 3 days. Her urine amylase level was 1717 U/L upon admission, and her condition was initially treated as acute pancreatitis. Unfortunately, the patient demonstrated abdominal guarding after 24 h; thus, urgent computed tomography (CT) was performed. CT revealed the presence of a dilated small bowel. She underwent emergency laparotomy, wherein a gangrenous small bowel with no evidence of saponification at the lesser sac was noted. Due to the non-specific nature of hyperamylasaemia, an alternative diagnosis other than acute pancreatitis should be considered if the clinical symptoms are not suggestive of pancreatitis or the condition worsens despite conservative management.

Purpose: Laparoscopic appendicectomy (LA) has several advantages over conventional open appendicectomy (OA). However, about 5% to 10% of LA patients still need to be converted to open surgery. Identifying risk factors that contribute to conversion to OA allows for early identification of patients who may benefit from primary OA. This study aimed to determine the conversion rate of LA to OA and to identify its associated risk factors among patients with acute or perforated appendicitis. Methods: A retrospective review of medical records was performed among patients with acute or perforated appendicitis who underwent LA between December 2015 and January 2017. With the use of multivariable logistic regression analyses, the predictors of conversion from laparoscopic to OA were investigated. Results: Out of 120 patients, 33 cases were converted to OA which gives a conversion rate of 27.5%. Among 33 patients who were converted to OA, 27 patients (81.8%) had perforated appendix, while in the LA group, perforated appendix cases consisted of 34.5% (P<0.001). Histopathology of the appendix was the predictor of conversion from LA to OA (adjusted odds ratio, 8.82; 95% confidence interval, 3.13–24.91; P<0.001). Conclusion The result from our study shows that the overall conversion rate for the study period was high. Patients with perforated appendicitis had a higher risk of conversion to OA. Therefore, preoperative diagnosis of perforated appendicitis may be paramount in predicting conversion to OA.