Serum amylase level determinations provide one of the most specific means of making the diagnosis of inflammatory disease of the pancreas. However, it has been well established that increased concentrations of serum amylase may be produced, perhaps indirectly, by a variety of other conditions not associated with intrinsic pancreatic pathology. The list of such conditions is long and includes perforated peptic ulcer, peritonitis, acute gallbladder disease, choledocholithiasis, biliary dyskinesia, dissecting aneurysm of the aorta, pneumonia, bronchogenic carcinoma, intestinal obstruction, uremia, and mumps (whether or not pancreatitis is present).1They may also occur after the injection of morphine or codeine. In these conditions, however, the levels of serum amylase are rarely of the same magnitude as those attained in the early phases of acute pancreatitis, and they usually do not exceed 4001bto 6002Somogyi units. In the case to be described, much higher levels of serum amylase