ARE DRAIN FLUID AMYLASE LEVELS HELPFUL ON SECREENING PANCREATIC FISTULA SECONDARY TO PANCREATIC INJURY DURING EMERGENCY SPLENECTOMY?

Abstract

Objective: Splenectomy is a major surgical intervention that brings several complications as well as saving life in the surgical treatment of blunt/penetrating spleen trauma. Although it is a highly standardized procedure in terms of the surgical technique used, pancreatic tail injuries can also be observed, especially during dissection and ligation of the splenic hilum. In this study, we investigated the possible helpful effects of the amylase levels of serum and drainage fluid when there was suspicion for pancreatic injury during splenic hilum dissection.Material and Methods: Forty-two patients who underwent splenectomy under emergency conditions for splenic injury secondary to acute trauma were included in the study. Nine of the patients developed pancreatic leakage/fistula (Group-1), while 33 did not in the control group (Group-2). Amylase levels measured in both the drain in the site of the surgery and in the serum at postoperative 8, 24, 48 and 72nd hours period were compared. Patients with severe systemic diseases and former hepatobiliary disease excluded.Results: There was no statistically significant difference in mean blood amylase levels between Group-1 and Group-2 (p>0.05), however, when it was examined with regard to the measured mean amylase levels, the measurement values of Group-1 were significantly higher than those of Group-2 (p<0.05).Conclusion: Considering tissue ischemia-necrosis, intraabdominal infection-abscesses, possible intraabdominal adhesions, and other serious complications occurred secondary to chemical trauma as a result of the dissemination of pancreatic secretions into the peritoneal cavity, it is very important to protect the peritoneal cavity from contact with these enzymes. For this purpose, we suggest that the use of early stage drainage fluid amylase measurement is very important.