Accuracy in diagnosis of acute pancreatitis.

During an eight-year period, 113 cases of acute pancreatitis were studied to determine the accuracy and modes of diagnosis in the first attack. In 65% of cases, a confident diagnosis was made on a combination of the clinical picture and a marked elevation of the serum amylase level. Diagnosis on laparotomy was made in 30% of cases, and autopsy diagnosis in the remaining 5%. Cullen's and Grey Turner's signs, radiology test results, and the presence of hyperglycaemia were of little or no diagnostic value. Recently developed laboratory tests may increase the diagnostic yield in the future. The precise indications for laparotomy diagnosis in the first attack are discussed. Laparotomy for diagnosis did not increase the mortality rate in this series.