Annular pancreas overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Annular pancreas is a rare condition in which the second part of the duodenum is surrounded by a ring of pancreatic tissue continuous with the head of the pancreas. This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines. It occurs in 1 out of 12,000 to 15,000 newborns.[1] [2]

Pathophysiology

Annular pancreas is typically associated with abnormal embryological development, however adult cases can develop. It can result from growth of a bifid ventral pancreatic bud around the duodenum, where the parts of the bifid ventral bud fuse with the dorsal bud, forming a pancreatic ring. It can also result if the ventral pancreatic bud fails to fully rotate, so it remains on the right or if the dorsal bud rotates in the wrong direction, such that the duodenum is surrounded by pancreatic tissue. Blockage of the duodenum develops if inflammation (pancreatitis) develops in the annular pancreas.

Diagnosis

X Ray

Postnatal diagnostic procedures include abdominal x-ray and ultrasound, CT scan, and upper GI and small bowel series

CT

CT or MRI studies may show normal pancreatic tissue, with or without a small pancreatic duct, encircling the duodenum.

Treatment

Surgery

Surgical resection is recommended for symptomatic cases. Treatment usually is bypassing the obstructed segment of duodenum by duodeno-doudenostomy. Another approach is laparoscopicgastrojejunostomy.[3]

References

  1. Lainakis N, Antypas S, Panagidis A, et al (2005). "Annular pancreas in two consecutive siblings: an extremely rare case". European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift für Kinderchirurgie 15 (5): 364–8. doi:10.1055/s-2005-865838. PMID 16254852.
  2. Yu, Jinxing, Turner, Mary Ann, Fulcher, Ann S., Halvorsen, Robert A.Congenital Anomalies and Normal Variants of the Pancreaticobiliary Tract and the Pancreas in Adults: Part 2, Pancreatic Duct and Pancreas. Am. J. Roentgenol. 2006 187: 1544-1553
  3. De Ugarte DA, Dutson EP, Hiyama DT (2006). "Annular pancreas in the adult: management with laparoscopic gastrojejunostomy". The American surgeon 72 (1): 71–3. PMID 16494188.

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