Sinha Sidhartha, Khan Hamed, Timms Peter M, Olagbaiye Olufemi A
Southend University Hospital NHS Foundation Trust, Essex, UK.
J Emerg Med. 2010 May;38(4):463-6. doi: 10.1016/j.jemermed.2008.04.042. Epub 2008 Nov 7.
Although salivary-type hyperamylasemia is known to occur with ovarian pathologies such as salpingitis and adenocarcinoma, pancreatic-type hyperamylasemia and hyperlipasemia are considered to be highly specific for pancreatitis.
To discuss the interpretation of hyperamylasemia in the context of acute abdominal pain, implications for management, and to review the literature relating to non-pancreatic causes of hyperamylasemia and hyperlipasemia.
We present the case of a 25-year-old woman who presented with an acute abdomen and a markedly elevated pancreatic-type amylase and lipase in whom acute pancreatitis was suspected. Further investigations showed that the underlying pathology was actually a ruptured ovarian cyst causing massive intra-abdominal hemorrhage and necessitating emergency laparotomy.
This case represents an initial report of pancreatic-type hyperamylasemia and hyperlipasemia occurring with ovarian pathology and hemoperitoneum. Although these derangements may have been secondary to peritoneal irritation, this case raises the possibility that ovarian tissue is able to secrete large amounts of pancreatic-type amylase and lipase in addition to salivary-type amylase. Clinicians should be aware that simultaneous elevations of both enzymes are not necessarily pathognomic of acute pancreatitis.
尽管已知唾液型高淀粉酶血症会伴随输卵管炎和腺癌等卵巢病变出现，但胰腺型高淀粉酶血症和高脂血症被认为对胰腺炎具有高度特异性。
讨论在急性腹痛背景下高淀粉酶血症的解读及其对治疗的影响，并回顾与高淀粉酶血症和高脂血症的非胰腺病因相关的文献。
我们报告了一名25岁女性的病例，该患者出现急腹症，胰腺型淀粉酶和脂肪酶显著升高，怀疑患有急性胰腺炎。进一步检查显示，潜在病因实际上是卵巢囊肿破裂导致大量腹腔内出血，需要进行急诊剖腹手术。
本病例是卵巢病变和腹腔积血伴发胰腺型高淀粉酶血症和高脂血症的首例报告。尽管这些紊乱可能继发于腹膜刺激，但该病例提示卵巢组织除了能分泌唾液型淀粉酶外，还可能分泌大量胰腺型淀粉酶和脂肪酶。临床医生应意识到这两种酶同时升高并不一定是急性胰腺炎的特征性表现。
