Annular pancreas: Radiological features of a rare case of infantile vomiting

Abstract

Our purpose is to illustrate the radiological aspects of the annular pancreas as an etiology of duodenal obstruction in infants. We report the case of a 4-month-old girl, who was admitted to our department with postprandial vomiting evolving since birth. The initial examination found a severely dehydrated patient. Abdominal ultrasound showed gross dilatation of the stomach and duodenum, it also showed pancreatic tissue surrounding the duodenum, suggesting a diagnosis of annular pancreas as the cause of the duodenal obstruction. Post-contrast abdominal CT showed the gastric and duodenal dilatation, and a ring of pancreatic tissue surrounding uncompletly the second portion of the duodenum. The patient underwent a bypass surgery which consisted in a duodeno-duodenostomy with simple post-operative follow-up and no recurrence of digestive symptoms. Annular pancreas is a rare pathology to be sought in neonatal obstruction. A good knowledge of radiological semiology is essential for a good diagnostic approach. However, surgery is the only effective way to diagnose and treat this pathology.

Keywords: Annular pancreas; Imaging; Pediatrics; Vomiting.

Fig. 1

Ultrasonographic image showing pancreatic tissue (white arrow) surrounding the second portion of duodenum (black star).

Fig. 2

Barium X-ray. Upper gastrointestinal system was obtained and showed that the stomach, the bulbus and the first and second parts of the duodenum were enlarged.

Fig. 3

Axial (A,B) and coronal (C) thin-section enhanced abdominal CT showing the gastric and duodenal dilatation (white star), and the ring of pancreatic tissue surrounding uncompletly the second portion of the duodenum (white arrows).