The use of serum Amylase as a predictive factor for mortality in Perforated Duodenal Ulcer

Background: High serum amylase is frequently found in perforated duodenal ulcer (PDU) ,the rise in serum amylase occurs in cases of perforated peptic ulcer partly as a result of increase leakage of pancreatic enzymes rich fluid from the perforation site with subsequent absorption by peritoneal lymphatics & partly due to damage of pancreases by digestive enzymes that spilled through the perforation. Objectives: To determine the significance of abnormally high level of serum amylase in patients undergone operation for PDU, to study the factors that tend to bring about elevated serum amylase level in these patients. Patients and Methods: A prospective study of 250 patients with perforated duodenal ulcer (PDU) at al kindy teaching hospital, Baghdad, Iraq from June 2008august 2010. patients were examined clinically and investigated by blood test, chest xray, plain Xray of the abdomen. &ultrasonography (U/S). Resuscitation by intravenous fluid, antibiotic were done. Explorative laparotomy performed for all patients, repair of perforation done by simple omental patch. Data regarding site, size of perforation, amount of spilled fluid and operative finding were recorded. Results: Two hundred fifty patients included in this study with proven PDU, 222 (88.8 %) were male and 28 (11.2 %) were female, male to female ratio is 8 :1. The mean age was 38 years, ranging from 22-70 years. The over all mortality was 14.4%. In 210 patients( 84%), the serum amylase was within normal range, the mortality in this group was 10 %. The other 21 patients (16%) had level of 200 or above, the mortality in this group was 37.5 %. Mortality was 5 % in cases with mild intra peritoneal fluid spillage, 9% in moderate, 25% in large amount & 39 in massive intra peritoneal spillage. The size of perforation has prognostic significance, for the larger the perforation, the higher the mortality. Conclusions: Limiting surgical delay in patients with PDU seems to be of paramount importance in reducing the mortality in these patients. In patients with PPD, the high serum amylase the high mortalityrate.