LAUSR

Dear Editor, A 27yearold female presented to the emergency department with severe, continuous, epigastric pain radiating to the back for the last 2 weeks. It was associated with recurrent, nonbilious and nonprojectile vomiting. There was progressive abdominal distension; this was initially associated with nonpassage of flatus and faeces. However, it continued to progress even after she started passing flatus and faeces. She had lowgrade fever, shortness of breath, and decreased urine output for the last 5 days. Her last childbirth was 3 months back by an emergency lower segment caesarean section, performed in view of foetal bradycardia. The patient did not have any other underlying comorbidity and there was no reported postoperative complication. She had been admitted at another facility for the past 7 days, where an abdominal ultrasound revealed distended gallbladder with multiple echogenic calculi in lumen, multiple peritoneal deposits, a moderate amount of free fluid in the peritoneal cavity and bilateral pleural effusion. Her serum lipase and amylase levels were 3410 U/L and 1032 U/L, respectively. She was diagnosed clinically as a case of acute pancreatitis secondary to gallstone disease, and was referred to our institute as she continued to worsen. At admission, her total leukocyte count (TLC) was 8800/microlitre, serum amylase was 28 U/L, ascitic fluid amylase was 271 U/L, and ascitic fluid TLC was 2600/ microlitre, comprised mainly of polymorphs. On ultrasonography,