Annular pancreas in an 11-year-old girl: a case report

Abstract

Annular pancreas (AP) is a rare cause of congenital duodenal obstruction that is usually discovered at the neonatal period, but clinical severities can vary over a wide range and definite diagnosis could be delayed until late childhood or adulthood. We report here a case of AP detected in an 11-year-old girl who had a long history of symptoms of partial duodenal obstruction. Upper gastrointestinal (UGI) study revealed narrowed second portion of duodenum by extrinsic compression, and computed tomography demonstrated complete ring of pancreatic tissue surrounding the second portion of the duodenum. Diamond-shaped duodenoduodenostomy successfully cured the patient, and the postoperative UGI study showed smooth passage through the bypass segment. Although rare, AP should be differentiated in children with unresolved symptoms of partial duodenal obstruction.

Recurrent Non-Bilious Vomiting in a Child

“…[ 8 ] The pancreatic tissue encircling the duodenum may be responsible for an extrinsic compression leading to partial obstruction, but an underlying intrinsic duodenal stenosis is actually the main cause of obstructive symptoms. [ 3 9 ] Pre-ampullary obstruction resulting in non-bilious vomiting seems to be more common in children with AP than in those with other aetiologies of duodenal obstruction. [ 8 ] These findings have an important clinical implication and explain the diagnostic delay in our patient.…”

“…[ 10 ] Plain radiography is usually sufficient to diagnose complete congenital duodenal obstruction and contrast study is generally not essential except when there is a suspicion of acute midgut volvulus. [ 3 10 ] However, the diagnosis of incomplete duodenal obstruction in a child with non-bilious vomiting by simple radiography is more likely to be missed since the double bubble or double stomach image is not constant. [ 10 ] CT and MRI may be useful but are unable to make the diagnosis in all cases.…”

“…It may manifest early in the neonatal period, but it may also have varied and often delayed symptoms, depending on the degree of obstruction, making diagnosis more challenging. [ 3 ]…”

Annular pancreas mimicking hypertrophic pyloric stenosis in a female infant

“…Annular pancreas was first recognized by Tiedemann in 1818 and from the early autopsy and surgical series the estimated incidence to be approximately 3 cases in 20,000 births and only 737 cases have been reported in the English literature [2] . Patients with an annular pancreas may also have other congenital anomalies, trisomy 21 (Down syndrome) was the most commonly associated followed with cardiac anomalies; such as atrioventricular canal, tetralogy of Fallot, ventricular septal defect, atrial septal defect, and cleft mitral valve; intestinal malrotation, tracheoesophageal fistula, gastrointestinal anomalies, genitourinary anomalies, cerebral palsy, spinal cord defect and up duodenal atresia and stenosis [2] , [3] .…”

A newborn patient with both annular pancreas and Meckel's diverticulum

“…[ 1 ] Patients most commonly present in infancy or early childhood because the second part of the duodenum is surrounded by pancreas parenchyma. [ 2 ] It is usually suspected during routine prenatal ultrasonography by the double bubble sign in the fetal abdomen and children are diagnosed and treated after birth. In adults, AP has been detected to be associated with peptic ulceration, duodenal obstruction and pancreatitis.…”