Vol. 3, Issue 4, Part I (2019)

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. Interestingly, the start of these trends all predated the use of H2 receptor blockers, or proton pump inhibitors, fibre optic endoscopy, and highly selective vagotomy. However, the incidence of emergency surgery and the death rate associated with peptic ulcers has not decreased nearly so dramatically.

Aims and Objectives: The purpose of this study is to study signs, symptoms, mode of presentation and post-operative complications associated with duodenal perforation and importantly to assess the Serum Amylase levels in duodenal perforation and correlate the levels with post-operative complications.

Materials and Methods: 60 patients who underwent surgery (Graham’s omental patch repair) for perforated duodenal ulcer in Department of General Surgery attached to Kamineni Institute of Medical Sciences were studied from December 2018 to November 2019. The following factors were analysed in terms of morbidity and mortality: age > 18 years; gender; chronic ingestion of NSAIDs; alcohol ingestion and smoking, hemodynamic status on admission; ASA status; site and size of perforation; type of peritoneal collection and Serum Amylase level on the day of admission. Postoperative complications like wound infection, wound dehiscence, postoperative leak, septicaemia, respiratory complications, acute kidney injury and death were assessed and correlated with the Serum Amylase levels.

Results: 60 patients included in this study with proven perforated duodenal ulcer, 54 (90%) were male and 6 (10%) were female, male to female ratio was 9: 1. The mean age was

58.4 years, ranging from 31-75 years. The overall mortality was 28%. In 34 patients (57%), the serum amylase was within normal range, the mortality in this group was NIL. The other 26 patients (43%) had level of 200 or above, the mortality in this group was

48%. The size of perforation has prognostic significance, for the larger the perforation, the higher the mortality. Patients who were operated after 24 hours of admission and who had shock (systolic BP <90 mm Hg) on admission had significantly elevated Serum amylase levels and mortality in this group was 100%.

Conclusion: 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 mortality rate.