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Erschienen in:
06.07.2022 | Images in Surgery
Annular Pancreas
Erschienen in: Indian Journal of Surgery | Ausgabe 3/2023
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A 43-year-old man was hospitalized with acute epigastric abdominal pain radiating to the back. He denied alcohol overconsumption and any medical or surgical history. Physical examination was unremarkable. Laboratory tests of the blood confirmed neutrophilic leukocytosis (24,850/m3 white blood cells and 23,930/m3 neutrophils). Serum amylase and lipase levels were normal. A contrast-enhanced abdominal computed tomography revealed pancreatic tissue completely wrapped around the second portion of the wall thickening of duodenum (Fig. 1A and B). Because of a possible duodenal lesion, the patient underwent the upper gastrointestinal endoscopy, which visualized diffuse mucosal congestion, edema and ulcer along the descending duodenum (Fig. 1C). Finally, he received the diagnosis of annular pancreas. Annular pancreas is rare, originates from failed or abnormal migration/rotation of the ventral pancreatic bud, which is associated with duodenal atresia and trisomy 21 [1, 2]. It may present with peptic ulcer, episodes of obstruction or recurrent pancreatitis [3]. After symptomatic therapy for this patient, he improved spontaneously with repeat esophagogastroduodenoscopy showing significant reduction in lesions of involved parts of the duodenum (Fig. 1D). The patient remains well with no further episodes of abdominal pain one year later.
Fig. 1
A, B CT revealed that pancreatic tissue completely wrapped around the second portion of the wall thickening of duodenum. C Upper gastrointestinal endoscopy visualized diffuse mucosal congestion, edema and ulcer along the descending duodenum. D Esophagogastroduodenoscopy showed significant reduction in lesions of involved parts of the duodenum
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