Clinical presentation

A previously healthy 16-year-old male student was admitted with acute abdominal pain after eating two large pizzas and drinking five pints (approximately 2.8 l) of beer (alcohol content 4.5%). Initial assessment revealed epigastric tenderness with elevated serum amylase (380 IU/l, normal 30–110 IU/l) and lipase (4398 IU/l, normal 23–300 IU/l) concentrations. There was no free gas on the chest radiograph. The patient developed increasing abdominal pain, tenderness, tachycardia and a lactic acidosis (pH 7.20, lactate 2.91 mmol/l) within 6 h. Contrast-enhanced abdominal CT (figure 1) was done 8 h after admission.