There was a case of an elderly man with amylase of more than a thousand with abdominal pain and distention and vomiting, who was admitted with pancreatitis. He was admitted with pancreatitis. He was treated with gastrointestinal decompression and pancreatitis, and his symptoms improved significantly and his blood amylase decreased. The CT came out today and the results were unexpected. The pancreas was normal in shape and size, and the peripancreatic exudate was not obvious. However, both the small intestine and colon were significantly dilated, although there was no air-fluid flat. The question arises, is there pancreatitis? What is the cause of the dilated intestinal ducts? Why is the amylase so high? Dilatation of the intestinal canal can occur secondary to acute pancreatitis and is common in cases of severe pancreatitis with massive exudation, which can lead to intestinal paralysis and impaired blood supply. If there is no exudation this reason does not exist. Then another cause has to be found. Two conditions are common in the elderly: first, lesions of the intestine itself, such as tumors, Crohn’s disease, diverticulosis, familial adenomatous polyposis (FAP), and second, intestinal vascular lesions, thrombosis or embolism of the arteries. At the time of admission, no signs of obstruction were seen in the standing abdominal film, and only dilatation and pneumatization of the right hemicolectum were seen, which could be incomplete intestinal obstruction, and treatment with gastrointestinal pressure, octreotide, antibiotics and rehydration was effective. Secondly, ischemic bowel disease cannot be excluded in the elderly. Enhanced CT and angiography can be performed. Amylase is an early screening tool for the diagnosis of pancreatitis and its role is unquestionable. However, it still has to be analyzed specifically. The diagnosis of pancreatitis cannot rely on amylase alone, but needs to be combined with symptoms and imaging. If the presence of pancreatitis is not confirmed by CT, other causes need to be considered. Amylase is secreted from the salivary glands and the pancreas, and most of it is secreted and enters the digestive tract. Mumps and pancreatitis are therefore the two main causes of elevated blood and urine amylase, and amylase isoenzymes should be checked if available. In pancreatitis, amylase release increases due to pancreatic inflammation, elevated pancreatic duct pressure, and rupture of the glandular vesicles, which causes a reflux into the blood. Since amylase has a small molecular weight and is easily excreted from the urine through the glomerular tubules, blood and urine amylase are elevated during an acute pancreatitis attack, and urinary amylase is elevated slightly later than blood amylase. Blood and urine amylase will be elevated in renal insufficiency because there is no outlet. Acute abdominal conditions such as cholecystitis, cholelithiasis or biliary obstruction, perforated gastroduodenal ulcer, intestinal obstruction, mesenteric thrombosis, and appendicitis can also lead to elevation of amylase. Elevated amylase in cholecystitis gallstone may be due to a transient impairment of pancreatic fluid excretion during lithotripsy or inflammatory bile duct spasm, and amylase may be elevated transiently. In ulcer perforation (especially duodenal bulb ulcer perforation), blood amylase is elevated because the intestinal contents contain a large amount of pancreatic fluid and amylase is absorbed by the peritoneum after entering the peritoneal cavity. Perforation of the posterior or medial wall of the duodenum may adhere to the pancreas and form a penetration, and repeated inflammatory stimulation may lead to enlargement or even inflammation of the pancreas. After intestinal obstruction, the intestinal lumen is dilated, the intestinal fluid is stagnant, the permeability of the intestinal wall is increased by edema, and the digestive fluid rich in pancreatic enzymes in the intestinal lumen is absorbed into the blood by leaking into the abdominal cavity through the damaged intestinal wall, or directly into the blood through the intestinal wall. Therefore, the degree of amylase elevation can be higher in intestinal obstruction. In severe pancreatitis, due to massive necrosis of pancreatic tissue, amylase can no longer be secreted, resulting in a low blood amylase level. Just like the progressive decrease of aminotransferase in liver failure. The regression at this point is considered to be bidirectional, and may be improving or worsening.