A Classic Case of Annular Pancreas and its Clinical Implications (original) (raw)
Annular pancreas producing duodenal obstruction: A case report
Open Journal of Gastroenterology, 2013
Annular pancreas is a rare congenital anomaly characterized by the presence of ectopic pancreatic tissue surrounding the duodenum. This malformation is usually asymptomatic in adults, but can manifests as pancreatitis, duodenal stenosis, or duodenal or gastric ulceration. We report the case of a young patient of 18 years old hospitalized for epigastric pain and vomiting, in whom radiological investigations showed an annular pancreas. At operation, a complete obstruction of the duodenum between its first and second parts was found, caused by an annular pancreas. No other congenital anomaly of the intra abdominal organs was noted. A gastroenterostomy was performed. Both the rarity of this congenital abnormality and its successful correction by surgical means have prompted us to make the following presentation.
Annular Pancreas; Delayed presentation a Case Report
IOSR Journals , 2019
Annular pancreas is a clinicopathological condition in which ectopic pancreatic tissue encircles around the duodenum and usually causes partial obstruction, but when associated with web or stenosis causes complete obstruction. These children usually present in neonatal period and infancy and straightway surgery is the treatment. Rarely presentation may be delayed as in this case who presented to us at 5 years of age with recurrent attacks of vomiting and a diagnosis of annular pancreas was made and the patient underwent duodenoduodenostomy.
SAS journal of medicine, 2022
Annular pancreas is a rare congenital anomaly characterized by the presence of ectopic pancreatic tissue around the duodenum. Usually diagnosed in the neonatal period, the annular pancreas can be responsible for intestinal obstruction in 1% of cases. In adults it is asymptomatic in 50% of cases, as it can be responsible for duodenal stenosis, pancreatitis, or duodenal or gastric ulcerations. We report two cases of duodenal stenosis secondary to an annular pancreas diagnosed in two adults in whom a surgical bypass was performed allowing resolution of symptoms.
Journal of LIberia Medical and Dental Association, 2017
Background: Annular pancreas is one of the rarest causes of acute duodenal obstruction in neonates. The exact prevalence of annular pancreas is unclear as many individuals with annular pancreas are asymptomatic. We present a 7-day old male neonate who presented with non-bilious effortless coffee-ground vomitus from birth. He passed meconium with no subsequent motion of stool for 6days. Her radiograph showed a double bubble sign. He was diagnosed with a neonatal duodenal obstruction. Objective: To highlight the challenges in the diagnosis of neonatal duodenal obstruction. Materials and methods: The study is a case report of Annular Pancreas causing duodenal obstruction. The chart was retrieved and reviewed for the patient’s age, sex, clinical presentation, diagnosis and treatment. A search was conducted on the MEDLINE database for all applicable research; clinical reviews, retrospective studies and case reports. Results: The patient underwent duodeno-duodenostomy for an annular pancreas and the postoperative course was uneventful. Conclusion: Annular Pancreas is a rare disease in neonates causing duodenal obstruction. Imaging is supportive, but the diagnosis is confirmed by laparotomy. Duodeno-duodenostomy remains a viable operative option in neonates, Recommendation: A high index of suspicion is required by clinicians for diagnosis to avoid complications of delayed surgery.
Proceedings (Baylor University. Medical Center), 2016
Annular pancreas is a developmental anomaly that can be associated with other conditions such as Down syndrome, duodenal atresia, and Hirschsprung disease. A band of pancreatic tissue, in continuity with the pancreatic head, completely or incompletely encircles the descending duodenum, sometimes assuming a "crocodile jaw" configuration. We present the case of an adult who presented with epigastric pain and vomiting and was found to have annular pancreas.
Annular pancreas – a rare cause of gastric obstruction in an 82-year-old patient
Annals of The Royal College of Surgeons of England, 2005
A nnular pancreas is an uncommon and rarely reported congenital anomaly and thus is rarely suspected. The pancreas is normally formed from the fusion of the dorsal and ventral pancreatic buds between the first 4-8 weeks of embryonic life. Annular pancreas is formed due to failure of the ventral bud to rotate and elongates to encircle the early part of the duodenum. It is one of the few medical conditions which can present itself in a wide range of clinical severities and can affect neonates to the elderly, thereby making the diagnosis difficult.
Annular pancreas: a rare cause of acute pancreatitis
JOP : Journal of the pancreas, 2011
CONTEXT Annular pancreas is an uncommon and rarely reported congenital anomaly which consists of a ring of pancreatic tissue encircling the duodenum. Despite the congenital nature of the disease, clinical manifestations may ensue at any age. CASE REPORT We herein report the case of a 72-year-old female with acute pancreatitis associated with duodenal obstruction. On radiologic examination, an annular pancreas was diagnosed. In view of her previous medical history and morphologic findings, we concluded that the acute pancreatitis was directly related to the congenital anomaly. Her clinical course was favorable after medical treatment. CONCLUSION Clinicians should note the possibility of annular pancreas in patients with acute pancreatitis.
Partial Annular Pancreas- A Time Bomb?
Scholars Journal of Medical Case Reports, 2021
Annular pancreas is a rare developmental anomaly. Partial annular pancreas is less known and is very rare. A band of pancreatic tissue continues from the pancreatic head and incompletely encircles the pancreas. This typically gives a “crocodile jaw” configuration. In symptomatic cases patients present mostly in 3rd to 6th decade of their life, with abdominal pain, postprandial fullness, vomiting, upper gastrointestinal bleeding, acute or chronic pancreatitis, and in rare instances, biliary obstruction. The person can also be asymptomatic; in that case it will be an incidental finding. We are presenting a case of partial annular pancreas causing nonspecific symptoms. This was an incidental finding, studied and managed in a tertiary care centre.
A strange case of double annular pancreas
JOP : Journal of the pancreas, 2013
The pancreas is a soft lobulated gland situated transversely across the upper part of the posterior abdominal wall. Its parts include the head, neck, body and tail. Annular pancreas is a rare condition where the head of the pancreas surrounds the second part of the duodenum like a ring. We observed a rare type of double annular pancreas where the uncinate process encircled the third part of the duodenum. A process from the head of the pancreas encircled the junction between the first and second parts of the duodenum incompletely. There was a large artery running along the anterior border of the pancreas. The artery took origin from the superior mesenteric artery. This case may be of interest to gastroenterologists and surgeons.
Unusual clinical presentation of annular pancreas in the adult
Pancreatology, 2005
Annular pancreas (AP) is a rare congenital anomaly, usually present in childhood, with symptoms due to duodenal obstruction; however, this condition can manifest in adulthood with abdominal pain, pancreatitis and pancreatic head mass. The authors present a case of AP observed in a 22-year-old patient that presented an unusual dual-phase clinical manifestation of duodenal obstruction in infancy that was treated by a duodenojejunostomy, and abdominal pain due to chronic pancreatitis in the adult age. MRI with cholangiopancreatography played a decisive role in achieving the correct diagnosis. The patient was treated by a pylorus-preserving Whipple procedure, with resection of the previous duodenojejunostomy. Pancreatic changes characteristic of chronic pancreatitis were demonstrated both in the AP and in the resected pancreatic segment. A marked biliopancreatic ductal anomaly not previously described in the literature was demonstrated by radiologic examination of the surgical specimen. The pathogenesis of AP, the importance of its association with benign and malignant pancreatic disease and the treatment alternatives are discussed by the authors.
Annular Pancreas, A Rare Cause of Acute Pancreatitis, A Case Report
2023
Annular pancreas is a rare congenital anomaly where a band of pancreatic tissue encircles the second part of the duodenum. Owing to its rarity, neither the true prevalence nor the precise etiology of annular pancreas is known. It is usually diagnosed incidentally on imaging, during an abdominal surgery, or on autopsy. Treatment is individualized according to symptoms, ranging from close follow up to surgical interventions. In this case report, we present a case of annular pancreas, including the patient's history and clinical assessment, as well as the diagnostic and therapeutic modalities.
Annular pancreas: a cause of gastric outlet obstruction in a 20-year-old patient
The American journal of case reports, 2014
Annular pancreas is a congenital anomaly that consists of a ring of pancreatic tissue partially or completely encircling the descending portion of the duodenum. It is formed due to the failure of the ventral bud to rotate, thus it elongates and encircles the upper part of the duodenum. It can present in a wide range of clinical severities, and can affect neonates to the elderly, making it difficult to diagnosis. Although diagnosis of annular pancreas can be made pre-operatively by upper GI series, upper GI endoscopy, or CT scan, 40% of diagnoses require surgery for confirmation. We report the case of a 20-year-old woman presenting with history of vomiting and weight loss since childhood. We present the clinical characteristics, surgical management in the form of bypass procedure done through a duodenojujenostomy, and follow-up of the patient. Annular pancreas occasionally presents in adults. Variable presentations have been described in the literature, including pancreatic neoplasm,...
Annular Pancreas with Duodenal Stenosis and Intestinal
2013
Objective – To describe a rare case of a combination of annular pan-creas with malrotation in early childhood. Case report – The patient is 2 year old aged girl with persistent non-bilious vomiting. She was vomiting several times a week, and over the ten days prior to presen-tation as many as several times a day. Upon presentation, the patient had an unremarkable abdominal exam with no abdominal pain. An upper gastrointestinal study showed extreme dilatation of the stom-ach and the duodenal bulb, and an abdominal computer tomography scan revealed an annular pancreas. Intra-operatively we find an an-nular pancreas and treated it by duodeno-duodenostomy, while the intestinal malrotation was treated by Ladd’s procedure. Conclusion – Annular pancreas is a rare congenital anomaly which in childhood is related to duodenal atresia or stenosis and often affiliated with in-testinal malrotation. Key words: Annular pancreas ■ Malrotation.
Annular Pancreas in Neonates; Case Series and Review of Literatures
Background: The annular pancreas is a rare congenital disorder of the pancreas first recognized in 1818. It is believed to result from faulty rotation of the ventral pancreatic bud in its course around the posterior aspect of the duodenal anlage. The duodenum is encircled and might be obstructed by normal pancreatic tissue. The management of the annular pancreas is still developing and under revision. Case Presentation: Six cases of neonatal intestinal obstruction secondary to the annular pancreas diagnosed, operated on, and involved in our study. Age, gender, maturity, age at referral, birth weight, clinical presentation, imaging findings, associated congenital anomalies, treatment, complications, and hospital stay were all studied. Polyhydramnios is found in 3 cases (50%). Down syndrome was diagnosed in one case. One patient has associated malrotation. Symptoms started earlier within the first 24 hours. Vomiting was bile stained in 4 cases (66.7%). Passing meconium, sometimes frequent, does not exclude the annular pancreas. Most patients show double bubbles sign on plain abdominal X-ray. All six neonates were treated with duodenoduodenostomy with excellent results. Survival was 100% and complications were minimum. Conclusion: The annular pancreas, although rare, is an important cause of neonatal duodenal obstruction. The accurate diagnosis is usually performed during laparotomy. Vomiting may contain bile or not, furthermore, passing meconium does not exclude this condition. The best and the excellent surgical option is diamond duodenoduodenostomy. This case series might be added to the registered cases of the annular pancreas to standardize the method of diagnosis and to define the best management.
A case with annular pancreas and accompanying ectopic pancreas
Laparoscopic Endoscopic Surgical Science
Congenital anomalies of the pancreas are quite common. The cases may present with different symptoms at different ages. While severe forms cause more noisy pictures in infancy and early childhood, mild forms may give symptoms in adulthood or they may be completely asymptomatic. Being aware of these anomalies guides clinicians in terms of diagnosis in clinical approach and helps prevent undesirable complications, especially during biliary, liver, and pancreatic operations. This case report aimed to present a case with annular pancreas and accompanying ectopic pancreas presenting in adult age with complaints consistent with severe upper gastrointestinal system obstruction with clinical, radiological, and endoscopic findings.
Annular pancreas in adults: a report of two cases and review of literature
JOP : Journal of the pancreas, 2013
Annular pancreas is one of the rare congenital anomalies that can manifest itself in adulthood also. No specific guidelines and protocols exist about management of such cases. We hereby discuss our experience with two such cases along with a brief review of literature about the subject. The first patient was a male aged 27 years and presented with features of duodenal obstruction. He underwent duodenoduodenostomy . The second patient, a male aged 32 years, also presented with features of gastric outlet obstruction. He underwent Billroth type 2 reconstruction. Both patients had an uneventful recovery. Annular pancreas in adults is a rare clinical scenario. Advancements in imaging modalities have brought to forefront an even larger number of such cases. In adults it is diagnosed mainly because of the complications that arise thereof. Gastroduodenal tuberculosis can be an important differential diagnosis in endemic areas. Treatment and operative protocols have to be individualized.
International Journal of Surgery Case Reports, 2016
Annular pancreas (AP) in adults is a rare embryologic abnormality detected after development of complications or as incidental finding. Diagnosis and treatment strategies for symptomatic adult AP remain controversial. We describe two different presentation of AP: a woman with a specific upper abdominal pain treated with medical therapy and a man with upper gastroenteric obstructive symptoms which underwent surgical duodeno-jejunal bypass. English language literature about annular pancreas etiology, diagnosis and treatment was reviewed. No specific guidelines and protocols exist about management of AP, therefore, treatment and operative approaches must be individualized. In consideration of the possible post-operative complications, surgical treatment should be reserved in case of failure of conservative medical therapies.
Pancreatology, 2019
Background and aims: Annular pancreas (AnnP) is a rare congenital abnormality that results from the presence of a complete or partial ring of pancreatic tissue surrounding the descending portion of the duodenum. While the clinical presentation and management of AnnP in neonates and infants has been well described, the complete spectrum of clinical presentation of AP in adults is not very clear. We aimed to describe the clinical spectrum of presentation and management of adult patients with AnnP. Methods: Using the electronic medical record, we identified 198 patients with radiologically and/or surgically confirmed AnnP evaluated at Mayo Clinic between 1995 and 2017. Results: The mean age of the study population at diagnosis was 55.1 (±18.3) years (60% female). 60% of patients did not have symptoms attributable to pancreatic disease at the time of diagnosis and were diagnosed incidentally. Computed tomography (CT) was the most common modality (64%) of diagnosis. Among symptomatic patients, abdominal pain (50%), duodenal obstruction (31%) and acute pancreatitis (16%) were the most common symptoms (non-exclusive). While most patients with duodenal obstruction required surgery, all patients with acute pancreatitis could be managed conservatively in the absence of competing indications for intervention. Conclusion: AnnP may remain asymptomatic well into adulthood and be incidentally detected on abdominal imaging done for other indications. While surgery remains the mainstay of treatment in patients presenting with duodenal obstruction, a majority of these adult symptomatic patients with AnnP, including those with acute pancreatitis require no further treatment.
Portal Annular Pancreas: A Rare and Overlooked Anomaly
Polish Journal of Radiology, 2017
Portal annular pancreas is a rare pancreatic developmental anomaly which is often overlooked at imaging, and often diagnosed retrospectively when it is detected incidentally at the time of surgery. Although the anomaly itself is asymptomatic, it becomes important in cases where pancreatic resection/anastomosis is planned, because of varying ductal anatomy, risk of ductal injury and increased risk of postoperative pancreatic fistula formation.