Some recent reports indicate that faith in the diagnostic value of serum amylase determinations has been misplaced.1,2 Many disorders have been associated with very high amylase levels. Some of the more common in addition to acute pancreatitis include mumps, renal disease, and hepatitis,3 as well as intestinal obstruction and perforated ulcer.1,4,5 Some of these lesions require early surgery, whereas acute pancreatitis is usually treated without operation. As a result, serious errors in management have occurred. Consequently, a comprehensive review of a complete clinical experience with this test seems appropriate. Serum amylase determinations have been given much emphasis in the diagnosis of the acute abdomen at the University Hospital. It has been a policy to obtain blood immediately for this determination in every patient with upper abdominal pain, night or day, before any narcotics are given. As a result, 11,377 serum amylase determinations were recorded in a period