It is very difficult, occasionally, to make differential diagnosis of acute abdomen. Especially true is it to differentiate between acute pancreatitis and other acute abdomen because elevations of amyase content are seen other than pancreatitis.
In 1962 and 1967, Mansberger reported the value of peritoneal fluid ammonia levels in the differential diagnosis of acute abdomen and emphasized the usefulness of this test as an adjunctive diagnostic measure.
To reappraise the value of intraperitoneal fluid ammonia level, levels of ammonia and amylase of intraperitoneal fluid and serum were measured.
The results obtained were as follows.
1) Peritoneal fluid ammonia levels were elevated above 3.0¡/ml in patients with perforated gastroduodenal ulcer, strangulating obstruction of intestine, generalized peritonitis due to liver abseess, biliary peritonitis and urinary extravasation.
2) Peritoneal fluid ammonia levels were not elevated above 3. 0¡/ml in patients with acute pancreatis, intraperitoneal bleeding and simple mechanical intestinal obstruction.
3) The intraperitoneal fluid amylase levels were markedly increased in patients with perforated gastroduodenal ulcer and intestinal strangulating obstruction as wellas in acute pancreatitis.
4) No significant change of value was seen in blood ammonia levels.
5) The serum amylase levels were significantly increased in acute pancreatitis and were also increased above 200 units (Somogyi) in patients with perforated gastroduodenal ulcer (47%), intestinal perforation (29%) and intestinal obstruction (28%).
6) With the result of this study, the measurement of peritoneal fluid ammonia levels is valuable in making the differential diagnosis between acute pancreatitis and other acute abdomens.
|