Acute pancreatitis due to pancreatic tail herniation above the left hemidiaphragm

Abstract

A 29-year-old female with past medical history of gastroesophageal reflux disease and obesity came to the emergency department with a chief complaint of left upper quadrant abdominal pain. Her symptoms started three days prior after eating a meal. She described the pain as 10/10 intermittent pain that radiated to the back associated with nausea, vomiting, and diaphoresis. She denied alcohol abuse, trauma, or prior abdominal surgeries or procedures. She did not take any medications. Her vital signs were within normal limits. On physical exam, the only notable finding was left upper quadrant tenderness upon palpation.Laboratory studies showed leukocytosis of 14.8 × 10 3 cells/mm 3 (normal: 3.6-10.2 × 10 3 cells/mm 3 ), hematocrit 41.9% (normal: 36.7-47.1%), blood urine nitrogen of 11 mg/dL (normal: 8-21 mg/dL), creatinine of 0.83 mg/ dL (normal: 0.57-1.11 mg/dL), and calcium level of 9.3 mg/dL (