A cross-sectional study on elevated levels of serum amylase as a predictive factor for appendiceal perforation in patients with acute appendicitis

Sidhartha Patra; Deepak Kumar Das; Anup Kumar Sarkar; Abhisek Jenamani; Surya Narayan Barik; Ashoak Acharya

doi:10.18203/2320-6012.ijrms20253952

Authors

Sidhartha Patra Department of General Surgery, HMCH, Bhubaneswar, Odisha, India
Deepak Kumar Das Department of General Surgery, HMCH, Bhubaneswar, Odisha, India
Anup Kumar Sarkar Department of General Surgery, HMCH, Bhubaneswar, Odisha, India
Abhisek Jenamani Department of General Surgery, HMCH, Bhubaneswar, Odisha, India
Surya Narayan Barik Department of General Surgery, HMCH, Bhubaneswar, Odisha, India
Ashoak Acharya Department of General Surgery, HMCH, Bhubaneswar, Odisha, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20253952

Keywords:

Acute appendicitis, Perforation, Elevated serum amylase

Abstract

Background: Acute appendicitis is a common surgical emergency, and appendiceal perforation can lead to serious complications. Early identification of perforation is critical to improving outcomes. Serum amylase has been suggested as a potential marker for perforated appendicitis, but its diagnostic accuracy remains under-investigated. This study aimed to evaluate the diagnostic utility of elevated serum amylase levels as a predictive factor for appendiceal perforation in patients with acute appendicitis.

Methods: An observational study was conducted at Hi-tech medical college and hospital, Bhubaneswar, from December 2023 to February 2025. Sixty-four patients diagnosed with acute appendicitis and undergoing appendectomy were included. Preoperative serum levels of amylase and lipase were measured. Postoperative histopathological examination confirmed the diagnosis of perforated or non-perforated appendicitis. Statistical analysis was performed using chi-square test, t-test, and ROC curve.

Results: Among the 64 patients, 28 had perforated appendicitis, and 36 had non-perforated appendicitis. The mean serum amylase level was significantly higher in the perforated group (72.1±27.3 mg/dl) compared to the non-perforated group (30.1±11 mg/dl) (p<0.0001). No significant difference was observed between groups regarding serum lipase.

Conclusions: Elevated serum amylase levels were associated with perforated appendicitis in patients with acute appendicitis. Serum amylase demonstrated high diagnostic accuracy and could serve as a predictive marker for appendiceal perforation. Further studies are warranted to validate these findings and explore the clinical utility of serum amylase in the early diagnosis of perforated appendicitis.

Metrics

Metrics Loading ...

References

Guan L, Liu Z, Pan G, Zhang B, Wu Y, Gan T, et al. The global, regional, and national burden of appendicitis in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. BMC Gastroenterol. 2023;23(1):44. DOI: https://doi.org/10.1186/s12876-023-02678-7

Potey K, Kandi A, Jadhav S, Gowda V. Study of outcomes of perforated appendicitis in adults: a prospective cohort study. Ann Med Surg (Lond). 2023;85(4):694-700. DOI: https://doi.org/10.1097/MS9.0000000000000277

Smink DS, Fishman SJ, Kleinman K, Finkelstein JA. Effects of race, insurance status, and hospital volume on perforated appendicitis in children. Pediatrics. 2005;115(4):920-25. DOI: https://doi.org/10.1542/peds.2004-1363

Schwarz A, Bolke E, Peiper M. Inflammatory peritoneal reaction after perforated appendicitis: continuous peritoneal lavage versus non lavage. Eur J Med Res. 2007;12:200-5.

Akinfemiwa O, Zubair M, Muniraj T. Amylase. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2025.

Forster MJ, Akoh JA. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient. World J Gastroenterol. 2008;14(11):1795-96.

Forster MJ, Akoh JA. Perforated appendicitis masquerading as acute pancreatitis in a morbidly obese patient. World J Gastroenterol. 2008;14(11):1795-96. DOI: https://doi.org/10.3748/wjg.14.1795

Um JW, Kim KH, Kang MS, Choe JH, Bae JW. Macroamylasemia in a patient with acute appendicitis: a case report. J Korean Med Sci. 1999;14:679-81. DOI: https://doi.org/10.3346/jkms.1999.14.6.679

Muniraj T. Hyperamylasemia. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2025.

Rogers F. Elevated Serum Amylase: A Review and an Analysis of Findings in 1,000 Cases of Perforated Peptic Ulcer. Annul Surg. 1960;153(2):228-40. DOI: https://doi.org/10.1097/00000658-196115320-00009

Ganesh M, Salam I. Lessons to be learned: a case study approach--acute appendicitis masquerading as macroamylasaemia. J R SocPromot Health. 2008;128(3):140-2. DOI: https://doi.org/10.1177/1466424008089796

Menéndez-Arzac R, Cárdenas-Lailson E, Sanjuán-Martínez CA, Rebolledo-López G, Parraguirre-Martínez S, Léon L, et al. Acute intestinal ischemia serum markers for the diagnosis of acute appendicitis Cir Cir. 2005;73(6):449-52.