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Case Reports
. 2024 Aug 25;16(8):e67728.
doi: 10.7759/cureus.67728. eCollection 2024 Aug.

Adult-Onset Annular Pancreas: When to Intervene?

Iqbal M Ali  1 , Vijay Sai Reddy M  1 , Varun Shetty  1
Affiliations
Case Reports

Adult-Onset Annular Pancreas: When to Intervene?

Iqbal M Ali et al. Cureus. .

Abstract

Annular pancreas in adults is a rare congenital abnormality, often detected after the onset of complications or incidentally during autopsy. Diagnosis in adults is challenging due to the similarity of symptoms with other conditions. We report a case of a 55-year-old female who presented with a six-month history of intermittent colicky pain in the epigastric region, radiating to the back, accompanied by periodic nonbilious vomiting. Abdominal examination revealed mild tympany and succussion splash in the epigastric region, with no organomegaly, lumps, or visible peristalsis. The patient was treated successfully with gastrojejunostomy (GJ) and jejunojejunostomy (JJ), leading to a good recovery. This case highlights the importance of considering the annular pancreas in the differential diagnosis of adults presenting with similar symptoms, underscoring the diagnostic challenges faced by radiologists and surgeons.

Keywords: annular pancreas; autopsy; congenital abnormality; diagnosis; incidentally.

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Conflict of interest statement

Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. CECT image (presurgery) demonstrating annular pancreas surrounding the 2nd part of the duodenum
CECT: Contrast-enhanced computed tomography -White arrow indicates the annular ring of the pancreatic parenchyma surrounding the 2nd part of duodenum
Figure 2
Figure 2. Serial MRCP films showing annular pancreas (A-D)
MRCP: Magnetic resonance cholangiopancreatography (A) MRCP (T2 image/transverse cut): White arrow indicates the main pancreatic duct (MPD); yellow arrow indicates the encircling pancreatic parenchyma. (B) MRCP (T2 image/transverse cut): Yellow arrow indicates the MPD encircling the duodenum. (C) MRCP (T2 image/transverse cut): White arrow indicates the relation of MPD in relation to the common bile duct (CBD) indicated by the yellow arrow. (D) Reconstructed MRCP image showing the annular pancreas where the red arrow indicates right hepatic duct (RHD), yellow arrow indicates the gall bladder, green arrow indicates the common bile duct (CBD), white arrow indicates the annular pancreatic duct, and blue arrow indicates the MPD
Figure 3
Figure 3. Intraoperative image
The black arrow shows a thin rim of pancreatic tissue encircling the 2nd part of duodenum, resulting in proximal duodenal dilatation
See this image and copyright information in PMC

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