Elevated lipase & WBC Count, normal CT and Ultrasounds

I am a 30 year old female with acute abdominal pain (right upper and lower quadrant) for the last 5 weeks.  I had lab tests that showed an elevated WBC count of 17.5 and negative  for H. pylori.  I was recently diagnosed with polycystic ovary syndrome and started on metformin, which caused some diarrhea, around the same time the abdominal pain began.  I also have a history of kidney stones, and was born with one kidney, which is on the right side.  My primary care physician was concerned about kidney stone/obstruction, and sent me to my urologist.  He ordered and IVP, which was essentially normal, revealing small calcifications that have been present and have not moved in 3 years;  he did not feel my problem was renal related and said if the problem persisted for 2-3 more days to see my regular doctor.  I also discontinued the metformin to see if that was the source of the pain and diarrhea.  It has continued to persist.  In the meantime, my WBC count has been anywhere from 9.0 to 17.5, prompting my doctor to send me for an abominal CT, which was essentially normal.  Lab tests revealed an elevated sedimentation rate of 30, increased neutrophils on the CBC, and an elevated lipase at 159.  I was then sent to a gastroeneterologist, who did gallbladder ultrasound/HIDA scan, which was on the lower end of normal, with somewhat decreased gallbladder activity.  Is my next option exploratory surgery/diagnostic laparoscopy?  Any suggestions would be greatly appreciated!!

[Kevin Pho, MD]

You have had a comprehensive abdominal workup including many imaging studies.  Major diseases would have been ruled out already.  

With an elevated lipase, I would further image the pancreas.  The CT scan may not be a sensitive enough test in some cases.

An endoscopic ultrasound or MRI would be reasonable test to considered.  

I would also consider looking at the colon and upper GI tract.  This can be done with an upper endoscopy and colonoscopy.

These options can be discussed with your personal physician.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
www.kevinmd.com