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Annular pancreas producing duodenal obstruction: A case report  [PDF]
Abdesslam Bouassria, Hicham Elbouhaddouti, Ouadii Mouaqit, El Bachir Benjelloun, Abdelmalek Ousadden, Khalid Mazaz, Khalid Ait Taleb
Open Journal of Gastroenterology (OJGas) , 2013, DOI: 10.4236/ojgas.2013.33032

Annular pancreas is a rare congenital anomaly characterized by the presence of ectopic pancreatic tissue surrounding the duodenum. This malformation is usually asymptomatic in adults, but can manifests as pancreatitis, duodenal stenosis, or duodenal or gastric ulceration. We report the case of a young patient of 18 years old hospitalized for epigastric pain and vomiting, in whom radiological investigations showed an annular pancreas. At operation, a complete obstruction of the duodenum between its first and second parts was found, caused by an annular pancreas. No other congenital anomaly of the intra abdominal organs was noted. A gastroenterostomy was performed. Both the rarity of this congenital abnormality and its successful correction by surgical means have prompted us to make the following presentation.

A Classic Case of Annular Pancreas and its Clinical Implications
Nayak B,Satheesha; Mun Yooi,Ooi;
International Journal of Morphology , 2011, DOI: 10.4067/S0717-95022011000200043
Abstract: annular pancreas is a rare developmental anomaly where the head of the pancreas surrounds the second part of the duodenum like a ring. this may cause the duodenal constriction, obstruction, peptic ulcers and other complications. we saw a classic case of annular pancreas. the head of pancreas surrounded the second part of duodenum completely. however there was no narrowing of the duodenum. the case may be of importance for gastroenterologists, surgeons and radiologists.
Preduodenal Portal Vein (PDPV): A Very Rare Cause of Duodenum Obstruction  [PDF]
Beatriz Dinamarco, Elsner Gonzaga, Willy Marcus Fran?a, Pedro Luis Escher Parron, Patrícia Junqueira Mais Soares
Surgical Science (SS) , 2017, DOI: 10.4236/ss.2017.812055
Abstract: Congenital duodenal obstruction (CDO) is one of the most common anomalies presented in the neonatal period of intestinal obstruction, with an incidence of 1:10,000, and Preduodenal Portal Vein (PDPV) is a rare extrinsic cause of CDO. PDPV leads to CDO with a persistent vomiting, impairment of the oral feeding and weight loss, but other publications state an asymptomatic disease that may requires late surgical correction. Prenatal diagnosis of CDO, including PDPV, is evidenced by association of polyhydramnios with a dilated fluid-filled gastric and duodenum and a double-bobble image in the ultrasonography and permits a proper management of associated malformation, delivery, surgery and allows family counseling. PDPV is commonly associated to other intestinal obstruction such as extrinsic (annular pancreas, adhesive bands, malrotation, peritoneal bands, intestinal duplication), and intrinsic (atresia, web and stenosis), and also associated with cardiovascular anomalies, situs inversus, Down’s syndrome and polysplenia. This is full term 5 days old newborn, 2865 g girl, without prenatal diagnosis of CDO. It was not still established PDPV until surgery procedure such as Duodenoduodenostomy (Diamond-Shape) and can guide Paediatric Surgeons that face high intestinal obstruction in the neonate with or without prenatal diagnosis. In the ambulatory follow up after 4 months, baby has developed very well, in breast-feeding associated with formula-feeding with a normal weight gain (average of 550 g/month).
Annular pancreas intra operatively discovered: a case report  [cached]
Zeineb Mzoughi,Ben Abid Sadri,Miloudi Nizar,Hentati Hassen
Clinics and Practice , 2011, DOI: 10.4081/cp.2011.e82
Abstract: Annular pancreas is a rare congenital abnormality. This entity can rarely be symptomatic. Patients can present with gastrointestinal obstruction or acute pancreatitis. We report a case with a rich iconography, of an annular pancreas discovered intraoperatively. A 46- year-old woman was operated with the diagnosis of acute cholecystitis with common bile duct stones. At operation, a strip of pancreatic tissue (2 cm) completely encircled the second duodenum. Open cholecytectomy with choledocotomy and stones extractionwas done. Postoperatively, she developed an acute pancreatitis. The post-operative cholangiography showed the annular duct surrounding the second duodenum. Annular pancreas is rare. Symptoms may occur in newborn children. In adults, annular pancreas discovering is radiological or intra operatively.
Annular pancreas in adults (2 case reports).  [cached]
Machado N,Rajan N,Rao B
Journal of Postgraduate Medicine , 1991,
Abstract: Two cases of annular pancreas in adults are being reported. In the first case, a middle aged lady presented with duodenal obstruction and gastric ulcer. Anterior H. S. V. with posterior truncal vagotomy and isoperistaltic duodeno-jejunostomy relieved her symptoms. In the second case, a young girl presented with duodenal obstruction, severe wasting and gross dehydration. She had an uneventful recovery following a duodeno-jejunostomy.
Pancreaticobiliary malunion and incomplete pancreas divisum: an unusual cause of common bile duct obstruction
J Petrasek , , T Hucl , J Spicak
Advances in Medical Sciences , 2008, DOI: 10.2478/v10039-008-0002-3
Abstract: Purpose: Pancreaticobiliary malunion (PBM) is a distinct disease entity of the pancreatic and biliary ductal system defined as a condition in which the junction of the pancreatic and biliary ducts occurs above the duodenal wall. PBM may be combined with a stenosis of the distal common bile duct and pathological changes in the common bile duct wall (congenital cyst of bile duct), being a potentially malignant condition. Pancreas divisum, resulting from a fusion failure of the ventral and dorsal pancreatic buds, and characterized by a dominant Santorine duct, is considered to be a predisposing factor to recurrent attacks of acute pancreatitis. In incomplete pancreas divisum, the ventral and dorsal pancreas are connected by a segmental branch. Material and Methods: We report a case of a 33-year-old female patient with PBM associated with incomplete pancreas divisum, who had presented episodes of acute cholangitis due to a benign distal common bile duct stricture. Results: Treatment with choledochoduodenostomy and cholecystectomy provided thorough relief and resolution of symptoms. Conclusion: This is the first report of coexistent PBM and incomplete pancreas divisum in a Caucasian patient with unusually late clinical manifestation.
Annular Pancreas in Children: A Decade of Experience  [cached]
Murat Yigiter,Abdullah Yildiz,Binali Firinci,Onur Yalcin
Eurasian Journal of Medicine , 2010,
Abstract: Objective: Annular pancreas is an uncommon cause of duodenal obstruction in children. In this study, the clinical, radiological, and prognostic findings related to this disorder over a 12-year review period were analyzed.Materials and Methods: A retrospective review of 22 patients with annular pancreas who were treated with surgical repair between April 1998 and February 2010 was performed at two different pediatric surgical units. Presenting symptoms, associated anomalies, radiological findings, the type of surgery performed, postoperative outcomes, and complications were analyzed.Results: Twenty-two patients were identified. Thirteen of the 22 patients (59.1%) were born prematurely, 11 patients (50%) had low birth weight, 2 patients (9.1%) had very low birth weight and 1 patient (4.5%) had extremely low birth weight. The mean birth weight was 2285.23±675.12 g. (970-3300). All patients presented with vomiting, which was bilious in nine (40.9%). Nine patients (40.9%) had chromosomal anomalies. Corrective surgery consisted of duodenoduodenostomy in 9 patients (40.9 %), duodenojejunostomy in 9 patients (40.9%), and gastrojejunostomy in 4 patients (18.1%). Fourteen of the 22 patients have survived (63.6%). The causes of death were combinations of sepsis, pneumonia, brain hemorrhage, and cardiac anomaly. Conclusion: Infants with annular pancreas associated with duodenal obstruction were often born prematurely and/or had low birth weights; many had cardiovascular anomalies. Annular pancreas associated with duodenal obstruction correlated strongly with the trisomy 21 karyotype among the chromosomal anomalies, as did duodenal atresia. The oral feeding tolerance time was nearly the same for all patients regardless of the surgical procedure used.
E. Tarcoveanu,A. Vasilescu,,N. Vlad,Niculina Florea
Jurnalul de Chirurgie , 2011,
Abstract: Heterotopic (ectopic) pancreas is relatively rare and is defined as abnormally situated pancreatic tissue has no contact with the normal pancreas and has its own ductal system and blood supply. It is usually an incidental finding in clinical practice. It most often occurs in the proximal gastrointestinal tract – gastric heterotopic pancreas. It may become clinically evident when complicated by pathological changes such as pancreatitis, cystic dystrophy with obstruction as especially gastric outlet obstruction. In this report a 29 – year old man with nausea, recurrent vomiting an abdominal pain is described. Gastroduodenal endoscopic examination, upper GI barium X-ray, ultrasonography revealed a submucosal tumor at the prepyloric area on the posterior wall of the stomach with gastric outlet obstruction. A degenerated gastrointestinal stromal tumor was suspected. Limitated distal antrectomy was performed and a histological diagnosis of gastric heterotopic pancreas was confirmed. The patient had an uneventful postoperative course and was discharged 5 days after operation and remains healthy and symptom-free in the follow-up of 6 months. This is a report of a case of gastric outlet obstruction resulting for pancreatic heterotopia in the gastric antrum with cystic dystrophy after acute pancreatitis in an adult man. The incidence of symptomatic heterotopic pancreas is low and preoperative diagnosis is difficult. Although endoscopy ultrasound is helpful for diagnosis, it is difficult to distinguish from stromal tumor. Frozen section should be taken so as to distinguish heterotopic pancreas from malignant tumors. Surgical excision by minimally invasive approach provides symptomatic relief and is recommended.
Annular pancreas associated with duodenal carcinoma  [cached]
Enrico Br?nnimann, Silke Potthast, Tatjana Vlajnic, Daniel Oertli, Oleg Heizmann
World Journal of Gastroenterology , 2010,
Abstract: Annular pancreas (AP) is a rare congenital anomaly. Coexisting malignancy has been reported only in a few cases. We report what is, to the best of our knowledge, the first case in the English literature of duodenal adenocarcinoma in a patient with AP. In a 55-year old woman with duodenal outlet stenosis magnetic resonance cholangiopancreatography showed an aberrant pancreatic duct encircling the duodenum. Duodenojejunostomy was performed. Eight weeks later she presented with painless jaundice. Duodenopancreatectomy revealed a duodenal adenocarcinoma, surrounded by an incomplete AP. Thus, co-existent malignancy with AP can be present without obstructive jaundice and without being visible through preoperative diagnostics.
Retention of foreign body in the gut can be a sign of congenital obstructive anomaly: a case report
Pravas Subudhi, Shivaram Singh, Chudamani Meher, Omprakash Agrawal
Journal of Medical Case Reports , 2008, DOI: 10.1186/1752-1947-2-293
Abstract: We report here a child who presented with features of small gut obstruction which were attributed to a foreign body impacted in the intestine. At surgery, an annular pancreas was detected and the foreign body was found to be lodged in the distended proximal duodenum.The reported case highlights the fact that an impacted radio-opaque foreign body in a child should warn the pediatrician to the possibility of an obstructive congenital anomaly.Small round or oval objects that enter the stomach nearly always pass uneventfully through the gastrointestinal tract without requiring intervention. The retention of foreign objects within the duodenum is suggestive of partial obstruction, usually of congenital origin [1-3]. We describe a child presenting with features of high intestinal obstruction where retention of such an object led to the discovery of congenital duodenal stenosis producing partial obstruction.A 32-month-old boy presented with a history of intermittent vomiting over the previous 15 months. The vomitus was generally non-bilious but occasionally bilious. The parents also noticed intermittent distension of his abdomen which subsided after vomiting. The symptoms seemed to commence after the child had swallowed a metallic pendant which was coin-shaped and about 12 mm in diameter; at the time of swallowing, the child was about 17 months old. He underwent repeated plain upright radiographs of the abdomen to localize the foreign body and to determine whether it had been passed. However, these continued to detect the foreign body. The last plain radiograph (Figure 1) of his abdomen showed the foreign body to be located in the right lower quadrant and it was surmised that the intestinal obstruction was due to impaction of the foreign body in the region of the terminal ileum. The child's parents were therefore advised that their child needed to undergo surgery for relief of the obstruction. However, a review of the plain upright radiograph of the abdomen showed the pres
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