Symptomatic annular pancreas in newborns

Abstract

Background: The pancreas exhibits various types of anomalies, including aplasia, dysplasia, pancreatic cysts, duplication, and ectopia, of which the most common is annular pancreas. This study describes the characteristic features of 7 cases of annular pancreas diagnosed during exploration.

Material/methods: Seven newborns undergoing surgery for annular pancreas from 1990 to 1998 were analyzed. The cases were evaluated according to birth weight, sex, symptoms, methods of diagnosis, associated anomalies, and surgical treatment modalities.

Results: The mean birth weight of the patients was 2385 +/- 1002 g, the mean gestational age was 37.5 +/- 3.1 weeks. Four patients (42.8%) had associated anomalies, including intestinal malrotation (42.8%), intrinsic duodenal obstruction (28.5%), trisomy 21 karyotype (14.2%), cardiac malformation (14.2%), and Meckel's diverticulum (14.2%). Surgical treatment included duodenoduodenostomy (DD) in four patients and DD plus tapering enteroplasty (TE) plus placement of transanastomotic jejunal tube (TJT) in three patients.

Conclusions: Infants with annular pancreas associated with duodenal obstruction are generally premature or small for their gestational age. The symptoms observed in annular pancreas are related not only to extrinsic compression of the ectopic tissue, but also the duodenal stenosis associated with this malformation. Annular pancreas is most commonly associated with intestinal malrotation. It does not correlate as strongly with trisomy 21 karyotype as do the duodenal atresias, and oral feeding tolerance time is nearly the same between the DD and DD+TE+TJT groups.