Annular pancreas

December 31, 2014

Synonyms

Overview

Annular pancreas is a rare condition in which the second part of the duodenum is surrounded by a ring of pancreatic tissue continuous with the head of the pancreas. This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines. It occurs in 1 out of 12,000 to 15,000 newborns. The ambiguity arises from the fact that not all cases are symptomatic.

Symptoms

Symptoms occur when the ring of pancreas squeezes and narrows the small intestine so that food cannot pass easily or at all.

Newborns may have symptoms of complete blockage of the intestine. However, up to half of people with this condition do not have symptoms until adulthood. There are also cases that are not detected because the symptoms are mild.

Conditions that may be associated with annular pancreas include:

Down syndrome
Excess amniotic fluid during pregnancy (polyhydramnios)
Other congenital gastrointestinal problems
Pancreatitis

Newborns may not feed well. They may spit up more than normal, not drink enough breast milk or formula, and cry.

Adult symptoms may include:

Fullness after eating
Nausea or vomiting

Other symptoms:

Fullness following eating
Excess amniotic fluid during pregnancy
Abnormality of the pancreas
Duodenal stenosis

Causes

It is typically associated with abnormal embryological development, however adult cases can develop. Annular pancreas is problem present at birth (congenital defect).

Diagnosis

Tests include:

Abdominal ultrasound
Abdominal x-ray
CT scan
Upper GI and small bowel series

Prognosis

The outcome is usually good with surgery. Adults with an annular pancreas are at increased risk for pancreatic or biliary tract cancer.

Treatment

Treatment usually is bypassing the obstructed segment of dudenum by duodeno-doudenostomy. Another approach is laparoscopic gastrojejunostomy.