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Acute abdominal pain is one of the common complaints among patients presenting to the emergency room. Making an accurate diagnosis and starting appropriate treatment could be challenging. The diagnosis of AP is established by the presence of at least two of the following features: (i) typical abdominal pain; (ii) elevated amylase or lipase greater than three times the upper limit of normal; and/or (iii) characteristic findings on cross‐sectional imaging [4]. In general, patients with AP present with typical mid‐epigastric and/or upper abdominal pain, which sometimes radiates to the back. The intensity of abdominal pain does not correlate with the severity of the disease [5]. However, the presence of two or more systemic inflammatory response syndrome (SIRS) criteria within the first 24 hours may be associated with severe AP [6]. Physical examination findings often include tenderness in the upper abdomen. Late‐stage findings, such as skin discoloration around the umbilicus (Cullen sign) and flank (Grey Turner sign) from retroperitoneal hemorrhage, are uncommon and seen in less than 1% of patients [7]. When considering the diagnosis of AP, emergency room clinicians should order basic laboratory tests including complete blood count, lipase, amylase, liver function tests, blood urea nitrogen, creatinine, lactate dehydrogenase (LDH), and triglycerides.

The diagnosis of AP may be often overlooked [8]. While most patients present with abdominal pain, a small proportion of patients may present without any pain [9,10]. Very sick patients presenting to the emergency room may be sedated, intubated, or unconscious from medical conditions and it is often not possible to elicit history regarding abdominal pain or perform a good abdominal examination. In rare patients the pain may be only in the right upper quadrant or even in the lower abdomen. Unless routine blood work reveals elevated levels of amylase and/or lipase, a true pancreatitis might go undiagnosed for many days, while the patient is being treated for other causes of SIRS [11]. Serum amylase level has several limitations: it can be elevated in nonpancreatic diseases, and it returns to normal rapidly. Therefore, serum lipase, either alone or in combination with amylase, is preferred for diagnosis of AP [12]. However, physicians should remember that both amylase and lipase could be elevated in some critically ill patients without pancreatitis [11]. On initial presentation, contrast‐enhanced computed tomography (CT) and/or magnetic resonance imaging (MRI) of the pancreas should be performed only in patients where the diagnosis is uncertain from clinical and laboratory evaluation alone or in those where initial evaluation suggests a severe AP, in order to look for local complications like necrosis [13].