Case Report: Acute pancreatitis obscured by paralytic ileus in a patient with extensive burns

Extensive burns are associated with numerous severe complications. While paralytic ileus is relatively common, the co-occurrence of acute pancreatitis (AP) is rare, clinically insidious, and highly fatal. Diagnosis is particularly challenging due to masking by critical illness and coexisting ileus. We present a 32-year-old male with 65% TBSA flame burns and inhalation injury, admitted in hypovolemic shock. Resuscitation followed Parkland protocol, and escharotomy was performed. On day 2, abdominal distension and reduced bowel sounds suggested paralytic ileus, managed with nasogastric decompression and parenteral nutrition. By day 5, epigastric pain developed. Serum amylase and lipase (peaking at 580.38 U/L) and urinary amylase were elevated. Abdominal CT and MRI confirmed AP. Treatment included strict nil-by-mouth, aggressive support, and somatostatin. Serum lipase normalized with clinical improvement, while urinary amylase remained elevated until day 13. The patient recovered fully after skin grafts and was discharged. This case underscores that AP can be a lethal burn complication often obscured by ileus. Serum lipase is more reliable than urinary amylase for diagnosis and monitoring, especially with concurrent kidney injury. Vigilance, timely imaging, and multimodal support are critical. Persistent urinary amylase may reflect renal dysfunction rather than ongoing pancreatitis.