Annular pancreas in adults: single unit experience from a tertiary care centre of Northern India (original) (raw)
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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 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.
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.
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 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.
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.
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.