Analysis of Concentration of Pancreatic Enzymes in the Amniotic Fluid in Fetal Duodenal Atresia and Jejunal Atresia

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  • Nakahara Saori
    Department of Pediatric Surgery, Japanese Red Cross Medical Center
  • Matsumoto Junko
    Department of Gynecology and Obstetrics, Japanese Red Cross Medical Center
  • Ichinose Mari
    Department of Gynecology and Obstetrics, Japanese Red Cross Medical Center Department of Graduate School of Medicine, Tokyo University
  • Hatanaka Akira
    Department of Pediatric Surgery, Japanese Red Cross Medical Center Department of Graduate School of Medicine, Tokyo University
  • Takeyama Eriko
    Department of Pediatric Surgery, Japanese Red Cross Medical Center
  • Yoda Hitoshi
    Department of Neonatology, Japanese Red Cross Medical Center Department of Neonatology, University of Toho
  • Takemura Tamiko
    Department of Pathology, Japanese Red Cross Medical Center
  • Ishida Kazuo
    Department of Pediatric Surgery, Japanese Red Cross Medical Center

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Other Title
  • 胎児上部消化管閉鎖症における羊水中膵酵素濃度の解析
  • タイジ ジョウブ ショウカカン ヘイサショウ ニ オケル ヨウスイ チュウスイコウソ ノウド ノ カイセキ

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Abstract

Purpose: It has been reported that umbilical cord ulceration is associated with upper intestinal obstructions, and sometimes causes massive hemorrhage in a fetus. Although the regurgitation of gastric or intestinal juice into the amniotic fluid is suspected to induce development of umbilical cord ulceration, the exact mechanism is not clear. We studied the concentration of pancreatic juice in amniotic fluid to determine the influence of pancreatic juice and ulceration on the umbilical cord.<br>Methods: From July 2009 to June 2011, we studied the concentrations of pancreatic enzymes (pancreatic amylase lipase, pancreatic phospholipase A2, and trypsin) and of bilirubin and bile acid in the amniotic fluid of 6 cases with upper intestinal atresia (Group A), and 6 cases with hydroamnios without intestinal atresia (Group B).<br>Results: In Group A, the mean concentrations of lipase, pancreatic phospholipase A2, and trypsin were extremely elevated, registering 4,055 IU/ l, 63,050 ng/dl, and 30,400 ng/ml, whereas those in Group B were 3.5 IU/ l, 99 ng/dl, and 170 ng/ml, respectively. The mean concentration of bile acid in Group A was slightly higher than Group B: i.e. 18.5 μmol/ l (Group A) versus 1.5 μmol/ l (Group B). The mean concentration of pancreatic amylase in both Groups A and B were not affected.<br>Conclusions: The findings revealed that the concentrations of pancreatic enzymes and pacreatic amylase in amniotic fluid were extremely elevated in the cases with upper intestinal atresia. Pancreatic enzymes regurgitated by the fetus into the amniotic fluid may cause the umbilical cord ulceration.

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