STUDY DESIGN: A retrospective analysis of 10 patients with pancreatitis after traumatic spinal cord injury. OBJECTIVES: To determine the conditions leading to nontraumatic pancreatitis in spinal cord injury. SUMMARY OF BACKGROUND DATA: Little is known in the literature about pancreatitis after spinal cord injury. A few authors suggest a multifactorial pathogenesis. METHODS: Over a 4-year period the case reports of 338 patients with traumatically caused SCI were reviewed concerning p-amylase and/or lipase elevations. Acute pancreatitis was defined as an elevation of p-amylase and/or lipase of more than three times the upper normal limit. RESULTS: Ten of 338 patients had p-amylase and/or lipase elevations three times higher than the upper normal limit. All 10 were male with a mean age of 40.4 years. The average onset time of acute pancreatitis was 16 +/- 5.5 days after trauma. The usual etiologic factors of acute pancreatitis such as obstructive, toxic, or traumatic events were excluded. CONCLUSION: The clinical recognition of acute pancreatitis in paraplegic and quadriplegic patients is hampered by diminished or lost visceral sensitivity and therefore is based on laboratory investigations. The current authors therefore hypothesize that acute pancreatitis in the setting of high-level spinal cord injury may result from a combination of locally mediated sphincter of Oddi dysfunction and vagal dominant innervation of the pancreatic gland in autonomic failure.