A Rare Congenital Anomaly of the Pancreas: A Cadaveric Case Report

  • Srinivasa Rao Sirasanagandla Melaka Manipal Medical College (Manipal Campus), Manipal University. Manipal, Karnataka, India
  • Satheesha B Nayak Melaka Manipal Medical College (Manipal Campus), Manipal University. Manipal, Karnataka, India
  • Kumar M R Bhat Department of Anatomy, Kasturba Medical College, Manipal University. Manipal, Karnataka, India
Keywords: Annular pancreas, Celiac Artery, Duodenum, Endocrine Glands, Growth and Development


Context The pancreas is formed by ventral and dorsal pancreatic buds which arise from the endodermal lining of the gut. When the duodenum rotates to the right, the ventral pancreatic bud migrates dorsally and finally come and lie below the dorsal pancreatic bud. The developmental errors in the rotation of these components lead to annular pancreas. Case report We report a rare type of the incomplete annular pancreas around the contents of right free margin of lesser omentum. There was an extra pancreatic mass situated horizontally immediately above the superior border of the pancreas, situated behind the lesser omentum. The right end of this mass extended into the epiploic foramen and incompletely encircled the portal vein, bile duct and hepatic artery proper from behind. The left end of the extra pancreatic mass was extended towards the lesser curvature of the stomach. Further, this mass completely surrounded the origin of three branches of the celiac trunk. Its right end was found to be continuous with the head of the pancreas, close to the pylorus. Histology of the extra pancreatic mass revealed the presence of normal pancreatic tissue. Conclusion preoperative diagnosis of this rare anomaly is of clinical importance during surgeries involving the contents of right free margin of lesser omentum and epiploic foramen.

Image: Accessory pancreatic mass above the superior border of the body of pancreas.


Download data is not yet available.


Langman J. Medical embryology. 6th ed. Baltimore, Md: Williams & Wilkins; 1989: pp. 245-247.

Tadokoro H, Suyama M, Kubokawa Y,Sai JK. Persistence of the left part of the ventral pancreas may cause congenital biliary dilatation. Pancreas 2003; 27(1):47– 51.

The Japanese Study Group on Pancreaticobiliary Maljunction. Diagnostic criteria of pancreaticobiliary maljunction. Journal of Hepato-Biliary-Pancreatic Surgery 1994; 1(3):219– 221.

Tadokoro H, Takase M, Nobukawa B. Unusual fusion between ventral and dorsal primordia causes anomalous pancreaticobiliary junction. Pathology International 2008; 58(8):498–502.

Kiernan PD, ReMine SG, Kiernan PC, ReMine WH. Annular pancreas: may clinic experience from 1957 to 1976 with review of the literature,” Archives of Surgery 1980; 115(1):46–50.

Neupert G, Appel P, Braun S, Tonus C. Heterotopic pancreas in the gallbladder. Diagnosis, therapy, and course of a rare developmental anomaly of the pancreas. Chirurg 2007; 78:261-264.

Lainakis N, Antypas S, Panagidis A et al. Annular pancreas in two consecutive siblings: an extremely rare case. European Journal of Pediatric Surgery. 2005; 15(5): 364–368.

Ravitch, MM. The pancreas in infants and children. Surg Clin North Am. 1975; 55(2):377–385

Lecco TM. Zur morphologie des pankreas annulare. Sitzungsberichte der Heidelberger Akademie der Wissenschaften 1910; 119: 391–406.

Baldwin WA. A specimen of annular pancreas. The Anatomical Record 1910; 4(8):299–304.

Sessa F, Fiocca R, Tenti P et al. Pancreatic polypeptide rich tissue in the annular pancreas. A distinctive feature of ventral primordium derivatives. Virchows Archiv a Pathological Anatomy and Histology 1983; 399(2):227–232.

Suda K. Immunohistochemical and gross dissection studies of annular pancreas. Acta Pathologica Japonica 1990; 40(7):505–508.

Agha FP, Williams KD. Pancreas divisum: incidence, detection, and clinical significance. American Journal of Gastroenterology 1987; 82(4):315–320.

Lehman LA, Sherman S. Diagnosis and therapy of pancreas divisum. Gastrointestinal Endoscopy Clinics of North America 1998; 8(1):55–77.

Morgan DE, Logan K, Baron TH, Koehler RE, Smith JK. Pancreas divisum: implications for diagnostic and therapeutic pancreatography. American Journal of Roentgenology 1999; 173(1): 193–198.

Sandrasegaran K, Patel A, Fogel EL, Zyromski NJ, Pitt HA. Annular pancreas in adults. American Journal of Roentgenology 2009; 193(2):455–460.

Soto JA, Lucey BC, Stuhlfaut JW. Pancreas divisum: depiction withmulti-detector row CT. Radiology 2005; 235(2): 503–508.

Lewis FT. The bi-lobed form of the ventral pancreas in mammals. American Journal of Anatomy 1911; 12(3):389–400.

Kim SK, Hebrok M, Melton DA. Pancreas development in the chick embryo. Cold Spring Harbor Symposia on Quantitative Biology 1997; 62:377–383.

Slack JM. Developmental biology of the pancreas. Development 1995; 121(6):1569–1580.

Gress F, Yiengpruksawan A, Sherman S et al. Diagnosis of annular pancreas by endoscopic ultrasound. Gastrointestinal Endoscopy 1996; 44(4):485–489.

Ravitch MM, Woods AC Jr. Annular pancreas. Annals of Surgery 1950; 132(6):1116–1127.

Siew JX, Yap TL, Phua KB et al. Annular Pancreas: A Rare Cause of Upper Gastrointestinal Bleeding in a Child. J Pediatr Gastroenterol Nutr. 2012 Aug 3.

Jimenez JC, Emil S, Podnos Y, Nguyen N. Annular pancreas in children: a recent decade's experience. J Pediatr Surg 2004; 39(11):1654-7.

Kobayashi S, Honda G, Kurata M, Okuda Y et al. Pancreaticoduodenectomy in portal annular pancreas: report of a case. Surg Today 2012 Aug 2. [Epub ahead of print]

Jang JY, Chung YE, Kang CM, Choi SH et al. Two cases of portal annular pancreas. Korean J Gastroenterol 2012; 60(1):52-55.

Cunha JE, de Lima MS, Jukemura J, Penteado S, et al. Unusual clinical presentation of annular pancreas in the adult. Pancreatology 2005; 5(1):81-85.

Maker V, Gerzenshtein J, Lerner T. Annular pancreas in the adult: two case reports and review of more than a century of literature. Am Surg 2003; 69(5):404-410.

Mulholland KC, Wallace WD, Epanomeritakis E, Hall SR. Pseudocyst formation in gastric ectopic pancreas. JOP 2004; 5: 498-501.

Ormarsson OT, Gudmundsdottir I, Marvik R. Diagnosis and treatment of gastric heterotopic pancreas. World J Surg 2006;30:1682-1689.

Zhang L, Sanderson SO, Lloyd RV, Smyrk TC. Pancreatic intraepithelial neoplasia in heterotopic pancreas: evidence for the progression model of pancreatic ductal adenocarcinoma. Am J Surg Pathol 2007; 31: 1191-1195.

Christodoulidis G, Zacharoulis D, Barbanis S, et al. Heterotopic pancreas in the stomach: a case report and literature review. World J Gastroenterol 2007;13:6098-6100.

Barbosa J, Dockerty MB, Waugh JM. Pancreatic heterotopia review of the literature and report of 41 authenticated surgical cases. Surg Gynecol Obstet 1946; 82;527-542.

Chandan VS, Wang W. Pancreatic heterotopia in the gastric antrum. Arch Pathol Lab Med 2004; 128: 111-112.

Accessory pancreatic mass above the superior border of the body of pancreas
How to Cite
SirasanagandlaS., NayakS., & BhatK. (2013). A Rare Congenital Anomaly of the Pancreas: A Cadaveric Case Report. JOP. Journal of the Pancreas, 14(4), 454-457. https://doi.org/10.6092/1590-8577/1517