Amylase in the Management of Pancreatic Trauma

Abstract

Serum and urinary amylase values from 63 patients with pancreatic injuries were reviewed and correlated with clinical data. Forty-three patients were treated with débridement and drainage, 15 with distal pancreatectomy, and five with pancreatoduodenectomy. All of the latter survived. Of the 63 patients, six suffered injuries to other major structures and died. Serum amylase levels were elevated preoperatively in only 26% of the patients; postoperatively, they were routinely normal. Urinary amylase (diastase) levels were elevated in 93% of the patients immediately after operation and were the best indicator of postoperative pancreatitis. When nasogastric suction was discontinued on clinical grounds in the face of an elevated diastase level, 11 of 14 patients developed recurrent signs of pancreatitis. In patients with pancreatic injury, postoperative hyperamylasuria is an important indication for continued intensive therapy, including nasogastric suction even in asymptomatic patients.