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Review
. 2022 Apr-Jun;19(2):97-101.
doi: 10.4103/ajps.AJPS_180_20.

Annular pancreas in neonates; Case series and review of literatures

Haithem Hussein Ali Almoamin  1 , Sadik Hassan Kadhem  2 , Ansam Mahmood Saleh  3
Affiliations
Review

Annular pancreas in neonates; Case series and review of literatures

Haithem Hussein Ali Almoamin et al. Afr J Paediatr Surg. 2022 Apr-Jun.

Abstract

Background: The annular pancreas is a rare congenital disorder of the pancreas first recognized in 1818. It is believed to result from faulty rotation of the ventral pancreatic bud in its course around the posterior aspect of the duodenal anlage. The duodenum is encircled and might be obstructed by normal pancreatic tissue. The management of the annular pancreas is still developing and under revision.

Case presentation: Six cases of neonatal intestinal obstruction secondary to the annular pancreas diagnosed, operated on, and involved in our study. Age, gender, maturity, age at referral, birth weight, clinical presentation, imaging findings, associated congenital anomalies, treatment, complications, and hospital stay were all studied. Polyhydramnios is found in 3 cases (50%). Down syndrome was diagnosed in one case. One patient has associated malrotation. Symptoms started earlier within the first 24 hours. Vomiting was bile stained in 4 cases (66.7%). Passing meconium, sometimes frequent, does not exclude the annular pancreas. Most patients show double bubbles sign on plain abdominal X-ray. All six neonates were treated with duodenoduodenostomy with excellent results. Survival was 100% and complications were minimum.

Conclusion: The annular pancreas, although rare, is an important cause of neonatal duodenal obstruction. The accurate diagnosis is usually performed during laparotomy. Vomiting may contain bile or not, furthermore, passing meconium does not exclude this condition. The best and the excellent surgical option is diamond duodenoduodenostomy. This case series might be added to the registered cases of the annular pancreas to standardize the method of diagnosis and to define the best management.

Keywords: Annular; congenital; neonate; obstruction; pancreas.

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Conflict of interest statement

None

Figures

Figure 1
Figure 1
Plain abdominal X-rays erect shows double bubble sign
Figure 2
Figure 2
Contrast meal and follow through shows duodenal obstruction
Figure 3
Figure 3
Operative illustration of annular pancreas
Figure 4
Figure 4
Operative illustration of diamond duodenoduodenostomy
See this image and copyright information in PMC

References

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Supplementary concepts