Clinical Significances of Simultaneous Determination of Trypsin and Amylase Activities in Abdominal Discharge After Gastrointestinal Surgery

Akihide Kitamura, Eiji Nomura, Naobumi Minami, Toru Kawai

Ootori Icho Hospital

Although determination of amylase activity in fluid from abdominal drains is available for the detection of anastomotic leakage and pancreatic fistula, the activity of pancreatic proteases such as trypsin which might play an important role in the cytolysis of surrounding tissues has not been well documented. In this study, we investigated the activities of both trypsin and amylase in the postoperative discharge from abdominal drains after gastrointestinal surgery, as well as in pure pancreatic juice and in fluid from pancreatic cyst complicating acute pancreatitis. Concerning amylase activity, 100 to around 100,000 Somogyi U of activity per dl was seen in anastomotic leakage and pancreatic fistula following upper gastrointestinal surgery. With regard to trypsin activity determined by the method of Erlanger et al., pancreatic juice contaminated with intestinal fluid showed levels of 340∼825 U/ml. Although pure pancreatic juice showed less than 10 U/ml of activity, pancreatic fistula ranged from 1.5∼80 U/ml. Trypsin activity of less than 10 U/ml, concomitantly with amylase activity of no more than 100 Somogyi U per dl did not indicate the presence of pancreatic juice. Intravenous administration of aprotinin did not inhibit amylase activity but trypsin activity. These results indicate that simultaneous determination of trypsin and amylase activities in the discharge from abdominal drains can be useful in the postoperative management of gastrointestinal surgical patients.

Key words
enzyme assay of trypsin, amylase activity, abdominal drainage, pancreatic fistula, anastomotic leakage

Reprint requests
Akihide Kitamura Ootori Icho Hospital
653-9 Kami, Sakai, 593 JAPAN

Accepted
January 16, 1991

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