Correlation of Serum Amylase and Peritoneal Fluid Amylase with, Perforated Peptic Ulcer and its Complications.

Corresponding Author:
Dr. Ramneik Manglik,
Assistant Professor,
Department of General Surgery,
K. S. Hegde Medical Academy, (KSHEMA),
Mangalore-575018, Karnataka, India.
E-mail: ramneikmanglik@gmail.com

ABSTRACT

BACKGROUND

Despite a declining incidence of peptic ulcer disease, the incidence of peptic ulcer disease complicated by either bleeding or perforation has remained constant or in fact even increased. The patient, who may have a history of peptic ulceration, develops sudden onset severe generalized abdominal pain due to the irritant effect of gastric acid on the peritoneum. Treatment still consists of primary closure of the perforation by a single stitch suture and a convenient tag of adjacent omentum on top of this. PPU still remains a dangerous surgical condition, associated with high morbidity and mortality. We wanted to study the symptoms, signs, mode of presentation and post-operative complications in perforated peptic ulcer. We also wanted to study the serum amylase and peritoneal fluid amylase levels and their correlation with complications like haemodynamic status, other blood investigations also to co-relate the same with duration of perforation, amount of spillage, size, site and number of perforations.

METHODS

This was a prospective study conducted on 30 patients who were admitted with hollow viscus perforation diagnosed as peptic ulcer perforation intra-operatively. Thorough history was taken, and clinical examination was done. Mode of presentation with complications and post-operative complications were noted and were correlated with size, duration of perforation and also amount of fluid in peritoneal cavity. These parameters were correlated with serum and peritoneal fluid amylase levels along with other blood investigations. A follow up examination was conducted for a minimum period of 6 months.

RESULTS

There was a significant direct correlation between serum amylase levels and duration of perforation (r=0.41, p=0.03), size of perforation (r= 0.4, p=0.03) and amount of spillage (r= 0.66, p<0.001). 6 patients had serum amylase levels of more than 300, 4 presented with shock, 5 developed post op complication and 1 died.

CONCLUSION

Peptic ulcer perforation is a serious abdominal condition and mortality and morbidity increases as serum amylase and peritoneal fluid level amylase increases. Hence serum amylase and peritoneal fluid amylase can be used as indirect predictors for morbidity and mortality in cases of peptic ulcer perforation.

KEY WORDS

Peptic Ulcer Perforation, Serum Amylase, Peritoneal Fluid Amylase, Haemodynamic Status