The identification of clinically significant pancreatic injuries may require the use of other diagnostic studies. Reported incidence of missed pancreatic trauma on CT approximates 15%.49 Repeated CT imaging may suggest a pancreatic injury that required time to develop inflammation in the patient who remains persistently unwell. When obtained more than 3 hours after injury occurrence, an elevated serum amylase level may reflect pancreatic trauma. Used in this way, serum amylase levels are reasonably sensitive but lacking in specificity and are of limited value. Imaging of the pancreatic ducts with ERCP or magnetic resonance cholangiopancreatography may increase diagnostic yield, especially for those patients who have a suggestion of pancreatic injury. These additional modalities continue to be studied and may occasionally be valuable in planning therapy and the operative approach. (From Sabiston)
It has long been recognized that the initial serum amylase is neither sensitive nor specific enough to confirm or rule out an injury to the pancreas. 39-41 For example, salivary amylase elevations related to acute alcohol intoxication account for a significant percentage of the hyperamylasemia seen on admission to trauma centers. An elevated serum amylase level, particularly one drawn 3 hours after trauma, or a level remaining elevated or rising during a period of observation mandates further evaluation as well. (Trauma 2020)
“Takishima T, Sugimoto K, Hirata M, et al. Serum amylase level on admission in the diagnosis of blunt injury to the pancreas: its significance and limitations. Ann Surg. 1997;226:70.”