Annular Pancreas in Adults: A Report of Two Cases and Review of Literature
Abstract
Context 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. Case reports 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. Conclusion 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.
Image: Complete ring of pancreatic tissue encircling the second part of duodenum.
Downloads
References
Tieddmann F. Uber die Verschiedenheiten des Ausfuhrungsgangs der Bauchpeicheldruse bei dem Menshen und Sauugetiern. Dtsch Arch Physiol 1818;4;403.
Ecker, A. ( 1862 ) Bildungsfehier des Pankreas und des Herzens. Z. Art. Med. , 14 , 354.
Vidal, E ( 1905 ). 18e Congress de Chirugie, Paris, 1905. Proces Verbaux , Memoires et discussion ( Assosc Franc Chiru ), 18, 739.
Vasconcelos E, Sadek HM. Pancreas annular produzindo estenose duodenal. Rev Bras Gastroenterol 1949;1;535-551.
Karaski H, Mikuzami Y, Ishizaki A, Goto J, Yoshikawa D, Kino S etal. Portal Annular Pancreas. A notable pancreatic malformation. Frequency, morphology and implications for pancreatic surgery. Surgery 2009; 146:515-8.
Leeco TM. Zur Morphologie des Pancrease. Sitzungsb Akad Wiss Math-Nat Ki Wien 1910;119: 391-406.
Baldwin WM. A specimen of annular pancreas. Anat Rec 1910; 4:299-304.
Glazer G, Margulis A. Use of ERCP in Annular pancreas. Radiology 1979;133:303-306.
Kiernan PD, ReMine SG, Kiernan PC . Annular Pancreas. Mayo clinic experience from 1957 to 1976 with review of literature. Arch Surg 1980.
Hollander L, Marie M. Pankreas Annulare. Chirugische Gastroenetrologie, Berlin,Springer,1981;1058-60.
Zyromski NJ, Sandoval JA, Pitt JA. Dramatic differences between children and adults. J Am Coll Surg. 2008 May;206(5); 1019-25
Urayama S, Kozarek R, Ball T. Presentation and treatment of Annular pancreas in an adult population. Am J Gastroenterol 1993;88;467-468.
Friedmann AC, Dachmann AH . Radiology of biliary tract;1994;745-748.
Copyright (c) 2014 Ajaz Ahmed Wani, Shadab Maqsood, Parvez Lala, Sheema Wani
This work is licensed under a Creative Commons Attribution 4.0 International License.
As a member of Publisher International Linking Association, PILA, iMedPub Group’s JOP follows the Creative Commons Attribution License and Scholars Open Access publishing policies. Journal of the Pancreas is the Council Contributor Member of Council of Science Editors (CSE) and following the CSE slogan Education, Ethics, and Evidence for Editors.