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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 × 103 cells/mm3 (normal: 3.6–10.2 × 103 cells/mm3), 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 (normal: 8.6–10.2 mg/dL). Total bilirubin and alkaline phosphatase were within normal limits. Alanine aminotransferase and aspartate aminotransferase were slightly elevated at 52 U/L (normal 10–36 U/L) and 37 U/L (normal: 10–30 U/L), respectively. Lipid panel was unremarkable. Lipase was elevated at 265 U/L (lipase laboratory upper limit of normal is 69 U/L). Abdominal

Acute pancreatitis due to pancreatic tail herniation above the left hemidiaphragm