Annular pancreas producing duodenal obstruction: A case report

Abdesslam Bouassria, Hicham Elbouhaddouti, Ouadii Mouaqit, El Bachir Benjelloun, Abdelmalek Ousadden, Khalid Mazaz, Khalid Ait Taleb

Department of General Surgery “A”, University Hospital Hassan II, Fez, Morocco.
Department of General Surgery “B”, University Hospital Hassan II, Fez, Morocco.

DOI: 10.4236/ojgas.2013.33032                

Abstract

Annular pancreas is a rare congenital anomaly characterized by the presence of ectopic pancreatic tissue surrounding the duodenum. This malformation is usually asymptomatic in adults, but can manifests as pancreatitis, duodenal stenosis, or duodenal or gastric ulceration. We report the case of a young patient of 18 years old hospitalized for epigastric pain and vomiting, in whom radiological investigations showed an annular pancreas. At operation, a complete obstruction of the duodenum between its first and second parts was found, caused by an annular pancreas. No other congenital anomaly of the intra abdominal organs was noted. A gastroenterostomy was performed. Both the rarity of this congenital abnormality and its successful correction by surgical means have prompted us to make the following presentation.

Keywords

Annular Pancreas; Duodenal Stenosis; Gastroenterostomy

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Zyromski, N.J., Sandoval, J.A., Pitt, H.A., Ladd, A.P., Fogel, E.L., Mattar, W.E., Sandrasegaran, K., Amrhein, D.W., Rescorla, F.J., Howard, T.J., Lillemoe, K.D. and Grosfeld, J.L. (2008) Annular pancreas: Dramatic differences between children and adults. The Journal of the American College of Surgeons, 206, 1019-1025.
[2]	Heyries, L. and Sahel, J. (2010) Anomalies congénitales du pancréas. hépatologie [7-102-a-15] elsevier masson.
[3]	Bouassida, M., Sassi, S.E., Touinsi, H., Mighri, M.M., Chtourou, M.F., Chebbi, F. and Sassi, S.A. (2011) A rare cause of proximal intestinal obstruction in adults—Annular pancreas: A case report. Pan African Medical Journal, 10, 56.
[4]	Tiedemann, F. (1818) Annular pancreas. Deutsch Archives of Physiology, 4, 403.
[5]	Ecker, A. (1862) Bildungsfehler des pancreas und des herzens.
[6]	Lloyd-Jones, W., Mountain, J.C. and Warren, K.W. (1972) Annular pancreas in the adult. Annals of Surgery, 1972, 163-170.
[7]	Dowsett, J.F., Rode, J. and Russell, R.C.G. (1989) Annular pancreas: A clinical, endoscopic, and immunohistochemical study. Gut, 30, 130-135.
[8]	Yogi, Y., Shibue, T. and Hashimoto, S. (1987) Annular pancreas detected in adults, diagnosed by endoscopic retrograde cholangiopancreatography: Report of four cases. Gastroenterologia Japonica, 22, 92-99.
[9]	Kandpal, H., Bhatia, V., Garg, P. and Sharma, R. (2009) Annular pancreas in an adult patient: diagnosis with endoscopic ultrasonography and magnetic resonance cholangiopancreatography. Singapore Medical Journal, 50, e29.
[10]	Thomford, N.R., Knight, P.R., Pace, W.G. and Madura, J.A. (1972) Annular pancreas in the adult: Selection of operation. Annals of Surgery, 1972, 159-162.