A 45-year-old woman arrived in an emergency room with severe left upper abdominal pain radiating into her back and a lipase level of 900 units per liter, more than five times the top of the normal range. She had been having milder versions of the same attack since adolescence. Years earlier she had been told her spleen was hypermobile and sitting lower than it should. Nobody connected the two facts.
When surgeons finally went looking, the spleen was not in the left upper abdomen at all. It was in her pelvis, tethered by stretched peritoneum covering her pancreatic tail. The case report in Clinical Case Reports, from a team including gastroenterologists and a radiologist at the University of Nebraska Medical Center in Omaha, describes a mechanical cause of recurrent pancreatitis that rarely makes the differential diagnosis list.
