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Annular pancreas: a cause of gastric outlet obstruction in a 20-year-old patient.

Alahmadi R, Almuhammadi S - Am J Case Rep (2014)

Bottom Line: We present the clinical characteristics, surgical management in the form of bypass procedure done through a duodenojujenostomy, and follow-up of the patient.Variable presentations have been described in the literature, including pancreatic neoplasm, pancreatitis, obstructive jaundice, duodenal obstruction, and peptic ulcer diseases.Most studies of these lesions are single case reports or small series, which do not allow a surgeon to accumulate extensive experience; therefore, reliance on the combined experience of others in recognition and appropriate management has been the norm.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, King Faisal Specialist Hospital and Research Center (Gen Org) Jeddah Branch, Jeddah, Saudi Arabia.

ABSTRACT

Background: 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.

Case report: 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.

Conclusions: Annular pancreas occasionally presents in adults. Variable presentations have been described in the literature, including pancreatic neoplasm, pancreatitis, obstructive jaundice, duodenal obstruction, and peptic ulcer diseases. Most studies of these lesions are single case reports or small series, which do not allow a surgeon to accumulate extensive experience; therefore, reliance on the combined experience of others in recognition and appropriate management has been the norm.

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Annular pancreas.
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f1-amjcaserep-15-437: Annular pancreas.

Mentions: At laparotomy, there was a complete annular pancreas associated with significant gastric outlet obstruction, with massive dilatation of the stomach, pylorus, and upper part of the duodenum. Although the annular pancreas did not seem to be causing a tight band or external compression, it was still the transition point (Figure 1). On opening the duodenum, there was a duodenal web at the transition point in the second and third part of the duodenum; therefore, a bypass procedure was performed through a duodenojejunostomy proximal to the annular pancreas.


Annular pancreas: a cause of gastric outlet obstruction in a 20-year-old patient.

Alahmadi R, Almuhammadi S - Am J Case Rep (2014)

Annular pancreas.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4206480&req=5

f1-amjcaserep-15-437: Annular pancreas.
Mentions: At laparotomy, there was a complete annular pancreas associated with significant gastric outlet obstruction, with massive dilatation of the stomach, pylorus, and upper part of the duodenum. Although the annular pancreas did not seem to be causing a tight band or external compression, it was still the transition point (Figure 1). On opening the duodenum, there was a duodenal web at the transition point in the second and third part of the duodenum; therefore, a bypass procedure was performed through a duodenojejunostomy proximal to the annular pancreas.

Bottom Line: We present the clinical characteristics, surgical management in the form of bypass procedure done through a duodenojujenostomy, and follow-up of the patient.Variable presentations have been described in the literature, including pancreatic neoplasm, pancreatitis, obstructive jaundice, duodenal obstruction, and peptic ulcer diseases.Most studies of these lesions are single case reports or small series, which do not allow a surgeon to accumulate extensive experience; therefore, reliance on the combined experience of others in recognition and appropriate management has been the norm.

View Article: PubMed Central - PubMed

Affiliation: Department of General Surgery, King Faisal Specialist Hospital and Research Center (Gen Org) Jeddah Branch, Jeddah, Saudi Arabia.

ABSTRACT

Background: 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.

Case report: 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.

Conclusions: Annular pancreas occasionally presents in adults. Variable presentations have been described in the literature, including pancreatic neoplasm, pancreatitis, obstructive jaundice, duodenal obstruction, and peptic ulcer diseases. Most studies of these lesions are single case reports or small series, which do not allow a surgeon to accumulate extensive experience; therefore, reliance on the combined experience of others in recognition and appropriate management has been the norm.

Show MeSH
Related in: MedlinePlus