An elevation in the concentration of serum amylase following abdominal trauma or in the presence of acute abdominal symptoms is considered a reliable indication of pancreatic injury or disease. Recent studies of the plasma amylase concentration following battle injury have suggested that pancreatitis may result not only from direct injury to the pancreas but also as a result of indirect trauma, such as the transmission of force from a missile passing near the pancreas, injury at the time of surgery, or subsequent bacterial injury.3
On the basis of a study of the urinary amylase in 147 patients after subtotal gastrectomy, Millbourn4 reported an incidence of acute pancreatitis of 9%. In 6 of the 13 patients developing pancreatitis, the disease was subclinical; in 5 patients the disease was severe, causing the death of 2. The author blamed the complication on injury to the accessory pancreatic duct (Santorini). Warren,* emphasizing