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.
Causes
It is typically associated with abnormal embryological development, however adult cases can develop.
Presentation
Early signs of abnormality include polyhydramnios, or an excess of amniotic fluid, low birth weight, and feeding intolerance immediately after birth.
Diagnosis
Postnatal diagnostic procedures include abdominal x-ray and ultrasound, CT scan, and upper GI and small bowel series.
(30-year-old woman with annular pancreas and agenesis of dorsal pancreas associated with polysplenia syndrome. Axial true fast imaging with steady-state free precession (FISP) MR image (TR/TE, 5.5/2.4; field of view, 308 x 380 mm; slice thickness, 5 mm) reveals annular pancreas (white arrowheads) completely encircling descending portion of duodenum (black arrowheads). Note annular pancreatic duct (arrow) and left-sided inferior vena cava (IVC).)
Treatment
Treatment usually is bypassing the obstructed segment of dudenum by duodeno-doudenostomy. Another approach is laparoscopic gastrojejunostomy.
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