Annular pancreas detected in adults, diagnosed by endoscopic retrograde cholangiopancreatography: Report of four cases

Abstract

Four cases of annular pancreas diagnosed by endoscopic retrograde cholangiopancreatography (ERCP) are described and 105 cases of this anomaly in adults in Japan were reviewed. Among 105 cases, abdominal pain was the most frequent symptom. Concerning associated diseases, peptic ulcer was present in 24.8% and pancreatitis in 13.3%. In case 1, duodenal ulcer and pancreatic cyst were noted. Pancreatolithiasis was found in two cases (case 1 and 2). Case 4 presented the clinical features of acute pancreatitis. Out of 105 cases, well-described 26 were divided into six types. The following results were obtained. 1) The most frequent type was that in which the annular duct arose from the duct of Wirsung. 2) The next most frequent type was that in which the main pancreatic duct encircled the duodenum. 3) The other types corresponded to those in which the annular duct arose from the duct of Santorini and the common bile duct. We emphasized that ERCP is the most important procedure to find the characteristic features and to establish the therapeutic strategy in cases of annular pancreas.

Unusual clinical presentation of annular pancreas in the adult

“…With the improvements achieved in imaging techniques, the diagnosis of AP in adults increased in frequency [7] , men being affected more commonly than women [4,8] .…”

“…Yogi et al [8] classifi ed AP in 6 types, depending on the site of drainage of the annular duct ( table 1 ). The most common variety is type I, in which the annular duct fl ows directly into the main pancreatic duct.…”

Duodenal Carcinoma in a Patient with an Annular Pancreas: Rarity Personified

“…Clinical manifestation of AP in adults can present with cramping epigastric pain, postprandial fullness, vomiting, and weight loss [7,8,21]. Furthermore they can be an associated with pancreatitis, or gastric/duodenal ulcers.…”

“…Small intestine tumors account for about 5% of all alimentary tract tumors and the duodenum has a higher proportion of these tumors than the jejunum and ileum [6]. Primary Duodenal carcinomas (PDC) are rare and account for 20%-25% of all small bowel malignancies, whereas sarcomas, carcinoid and lymphomas [7,8] are even more less common. A PDC is difficult to diagnose because of its rarity, non-specific signs and symptoms and it inherently being overlooked during upper gastrointestinal endoscopy.…”

Annular Pancreas Causing Duodenal Obstruction: A Case Report

“…Yogi et al classified AP in six types depending on site of drainage of annular duct. [11] The most common variety is type I, in which annular duct flows directly into the main pancreatic duct. In Type II, Wirsung duct encircles the duodenum, but still drains at the major papilla.…”