Dena Shehata, Elliot L Servais
Elevated pleural amylase is widely used as a sensitive, noninvasive screen for anastomotic leak after esophagectomy. We describe a 71-year-old man with mild rise in pleural amylase on postoperative day 7 despite a normal esophagram and clinical status. Elevated serum amylase and lipase confirmed acute pancreatitis as the source, rather than an anastomotic complication. Serum and drain amylase levels normalized with supportive care. This case demonstrates that modest elevations in pleural drain amylase, although highly useful for early leak detection, may occasionally represent false positives from alternative processes such as pancreatitis, underscoring the importance of an evaluation for nonanastomotic causes.