ABSTRACT
Annular pancreas is a rare congenital anomaly which usually presents with gastrointestinal symptoms early in life. In adults mostly it remains asymptomatic or may present with abdominal or features of duodenal obstruction the increased diagnosis of which is attributed to the improved imaging modalities. We hereby report our experience of adult annular pancreas in whom clinical presentation initially mimicked gastric or duodenal outlet obstruction. Adult annular pancreas was diagnosed with the aid of computed tomography of the abdomen and treated successfully with Roux-en-Y isoperistaltic gastrojejunostomy.
ABSTRACT
El páncreas anular (PA) es una anomalía congénita infrecuente. Se caracteriza por la presencia de tejido pancreático ectópico alrededor del duodeno y puede estar asociado a obstrucción duodenal. Se presenta un paciente con cuadro de dolor abdominal y vómitos de 12 días de evolución. El laboratorio mostró elevación de lipasa en sangre. La tomografia computarizada de abdomen evidenció estómago y primera porción duodenal distendidos, en relación con una imagen en anillo de 5 cm de diámetro ubicada entre la cabeza del páncreas y la segunda porción del duodeno, sugestiva de PA. Ante la mala respuesta al tratamiento médico con reposo digestivo, sonda nasogástrica y nutrición parenteral, se decide conducta quirúrgica confirmando el diagnóstico de obstrucción duodenal por un PA. Se realiza gastroyeyunostomía en Y de Roux con buena evolución posquirúrgica. El PA puede manifestarse clínicamente como una obstrucción duodenal. Los casos con mala respuesta al tratamiento conservador requieren conducta quirúrgica para confirmar el diagnóstico y resolver la oclusión.
Annular pancreas (AP) is a rare congenital anomaly, characterized by ectopic pancreatic tissue surroun-ding the duodenum, that may associate with duodenal obstructon. We present a patent complaining of 12 days of abdominal pain and vomitis. Blood testis showed hyper-lipasemia. Computed tomography scan demonstrated stomach and frst duodenal porton distended in relaton to a 5 cm diameter image resembling a ring between the pancreatic head and the second porton of the duodenum, a well known characteristic of AP. Following a lack of clinical response to medical treatment, surgery was performed confirming a duodenal obstructon due to AP. Roux-en-Y gastrojejunostomy was done, with good postoperative outicome. Annular pancreas may present as a duodenal obstructon. For these cases, we suggest surgical treatment to confirm diagnosis and resolve the obstructon in cases with negative clinical response to conservative treatment.
ABSTRACT
Congenital duodenal obstruction is a rare cause of neonatal intestinal obstruction caused by various intrinsic and extrinsic congenital lesions. Annular pancreas is one of the causes of extrinsic duodenal obstruction and a duodenal web is one of the causes of intrinsic duodenal obstruction. The simultaneous occurrence of an extrinsic and intrinsic pathology is rare. Only four such cases have been reported in literature. We present a similar case of male neonate with partial duodenal obstruction caused by annular pancreas and an intrinsic duodenal web.
Subject(s)
Humans , Infant, Newborn , Male , Duodenal Obstruction , Intestinal Obstruction , Pancreas , PathologyABSTRACT
Congenital duodenal obstruction is a rare cause of neonatal intestinal obstruction caused by various intrinsic and extrinsic congenital lesions. Annular pancreas is one of the causes of extrinsic duodenal obstruction and a duodenal web is one of the causes of intrinsic duodenal obstruction. The simultaneous occurrence of an extrinsic and intrinsic pathology is rare. Only four such cases have been reported in literature. We present a similar case of male neonate with partial duodenal obstruction caused by annular pancreas and an intrinsic duodenal web.
Subject(s)
Humans , Infant, Newborn , Male , Duodenal Obstruction , Intestinal Obstruction , Pancreas , PathologyABSTRACT
Objective To investigate the clinical value of ultrasonic diagnosis for neonatal annular pancreas,analyze the reasons of missed diagnosis and misdiagnosis,and improve diagnostic accuracy of ultrasonography for this disease.Methods Clinical data of 98 newborns with annular pancreas confirmed by gastrointestinal contrast and surgery were analyzed retrospectively.Preoperative ultrasonogram were compared with the result of gastrointestinal contrast and surgery.Ultrasound images failed to be correctly dignosed were further studied to summarize diagnostic points for this disease.Results Among the 98 cases, 75 were correctly diagnosed by ultrasound with a diagnostic accordance rate of 76.5%,1 8 were missed diagnosed and 5 were misdiagnosed with a total misdiagnosis rate of 23.5%.Ten cases associated with other congenital gastrointestinal tract anomalies were missed diagnosed due to ignoring scanning pancreas.Five cases were missed diagnosed due to obvious intestinal cavity flatulence.Three cases were missed diagnosed due to lack of awareness of the disease.Five cases were misdiagnosed for duodenal stenosis or duodenal atresia.Conclusions Ultrasound has important diagnostic value for neonatal annular pancreas,providing the dignostic evidences for clinical treatment.Thus it can be used as the preferred auxiliary examination of the disease.Since annular pancreas is often accompanied by other gastrointestinal malformations and can be interfered by abdominal gas,missed diagnosis and misdiagnosis occurred easily.To improve the accuracy of ultrasonic diagnosis,all causes of neonatal gastrointestinal tract obstructions should be considered during the examination.
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Objective To evaluate the clinical significance of high frequency ultrasonography in the diagnosis of annular pancreas in neonates.Methods Ultrasound results,clinical data,operation results and complicating deformity of 19 neonates were reviewed retrospectively.The digestive tracts of 19 neonates,including stomach,duodenum,jejunoileum and colon,were examined with 8-12 MHz linear transducer before surgery.Results Of 19 neonates with annular pancreas,17 cases were diagnosed with ultrasound,the diagnostic rate was 89％.The pancreas tissue encircling the descending duodenum was directly displayed as a direct sign of ultrasonography and the expansion of the proximal end of the duodenum was presented as an indirect sign of ultrasonography in 17 neonates.There were 3 neonates with annular pancreas complicating intestine malrotation and 2 neonates with annular pancreas complicating duodenal membraneous stenosis.One neonate was misdiagnosised and the other was missed.Conclusions High frequency ultrasonography plays an important role in diagnosing annular pancreas and other digestive deformity in neonates.It can be used as the first choice for the neonatal annular pancreas.
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OBJETIVO: Este trabalho tem por objetivo fazer uma revisão da malformação congênita denominada de agenesia dorsal do pâncreas (ADP) e de outras malformações congênitas pancreáticas, com base em um caso clínico raro e exemplar da problemática das malformações pancreáticas. Pretende-se rever a informação mais recente publicada na literatura nacional e internacional acerca das malformações congênitas pancreáticas e investigar a diversidade de formas de apresentação clínica da ADP e de outras malformações congênitas do pâncreas. Pretende-se saber em que situações há indicação terapêutica, qual a altura mais adequada de intervir, quais as modalidades disponíveis para o tratamento médico e ou cirúrgico das malformações congênitas pancreáticas. RESULTADOS: A ADP é uma malformação muito rara que surge durante a organogênese. Nas últimas décadas, foi produzido um volume importante de informação genética e embriológica que ajuda a compreender as causas das malformações pancreáticas. As malformações pancreáticas têm de ser estudadas e compreendidas no seu conjunto. CONCLUSÃO: A malformação pancreática é uma causa de pancreatite aguda e crônica no adulto, pouco estudada. A possibilidade da existência de malformações pancreáticas deve estar sempre presente em doentes com pancreatite aguda ou crônica sem causa evidente.
OBJECTIVE: This study aimed to review the congenital malformation known as agenesis of the dorsal pancreas (ADP) and other pancreatic birth defects, based on a rare and exemplary clinical case of pancreatic malformations. The intent was to review the latest information published in the national and international literature on pancreatic birth defects, and to investigate the diversity of clinical presentations of ADP and other congenital pancreas abnormalities. The purpose was to identify which situations have therapeutic indication, the most appropriate time to institute treatment, and the currently available medical or surgical treatment of pancreatic congenital malformations. RESULTS: ADP is a very rare malformation that occurs during organogenesis. In the last decades, a large volume of embryological and genetic information has been obtained, helping to understand the causes of pancreatic malformations, which must be studied and understood as a whole. CONCLUSION: Pancreatic malformations are infrequently studied causes of acute and chronic pancreatiWtis in adults. The possibility of pancreatic malformations should always be considered in patients with acute or chronic pancreatitis with no evident cause.
Subject(s)
Female , Humans , Middle Aged , Pancreas/abnormalities , Pancreatitis/etiology , Diagnosis, Differential , PancreasABSTRACT
Objective To summarize our preliminary experience and evaluate the clinical value of laparoscope diagnosis and treatment for annular pancreas in neonates.Methods A retrospective review of laparoscope diagnosis and treatment for annular pancreas in 9 children from September 2009 to January 2013 was performed.Among them,5 were male,4 were female.The age was ranging from 1 to 13 d.A lowerpressure pneumoperitoneum of 5 ～ 8 mm Hg (1 mm Hg =0.133 kPa) was used.Eight cases of diamond duodenal anastomosis were performed under laparoscope after the diagnosis was established,and 1 case underwent procedure through slightly enlarged umbilical port site.Results Eight cases of diamond duodenal anastomosis were performed under laparoscope,and the operation time was 80 ～ 140 min (mean 105 min),in 1 case it was performed through umbilical port incision,the operation time was 64 min,and the length of incision was about 2.5 cm.Feedings were started at postoperative day 4 to 7 (mean 5 d),and patients were discharged at postoperative day 8 to 14 (mean 10 d).The cases were followed-up for 3 ～ 20 months (mean 6.7 months),and I case complicated with anal atresia died of pneumonia 6 months later.Other cases were uneventfully recovered and symptoms were alleviated with normal gastroenterological function,no preoperative symptoms recurred,and the nutrition and growth status was excellent.Conclusions Annular pancreas can be diagnosed through laparoscopy.Laparoscope diagnosis and treatment for annular pancreas has the advantages of small incision,micro-invasion and faster recovery,can be safely performed in neonatal period.
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Though congenital anomalies of the pancreas and pancreatic duct are relatively uncommon and they are often discovered as an incidental finding in asymptomatic patients, some of these anomalies may lead to various clinical symptoms such as recurrent abdominal pain, nausea and vomiting. Recognition of these anomalies is important because these anomalies may be a surgically correctable cause of recurrent pancreatitis or the cause of gastric outlet obstruction. An awareness of these anomalies may help in surgical planning and prevent inadvertent ductal injury. The purpose of this article is to review normal pancreatic embryology, the appearance of ductal anatomic variants and developmental anomalies of the pancreas, with emphasis on magnetic resonance cholangiopancreaticography and multidetector computed tomography.
Subject(s)
Humans , Cholangiopancreatography, Magnetic Resonance/methods , Multidetector Computed Tomography/methods , Pancreas/abnormalities , Pancreatic Diseases/congenital , Pancreatic Ducts/abnormalitiesABSTRACT
Eosinophilic pancreatitis is a rare disorder that frequently accompanies peripheral eosinophilia and/or eosinophilic gastroenteritis. Eosinophilic pancreatitis can mimic a pancreatic neoplasm by forming a pancreatic mass with focal pancreatic eosinophilic infiltration. Because eosinophilic pancreatitis responds well to steroid treatment, it is important to distinguish eosinophilic pancreatitis from pancreatic neoplasm. Thus, fine needle aspiration biopsy (FNAB) should be considered in patients with a pancreatic mass accompanied by peripheral eosinophilia and/or eosinophilic gastroenteritis. We describe a case of eosinophilic pancreatitis with annular pancreas that was diagnosed by FNAB. This is the first reported case of eosinophilic pancreatitis with annular pancreas diagnosed by FNAB.
Subject(s)
Humans , Biopsy , Biopsy, Fine-Needle , Enteritis , Eosinophilia , Eosinophils , Gastritis , Gastroenteritis , Pancreas , Pancreatic Diseases , Pancreatic Neoplasms , PancreatitisABSTRACT
Eosinophilic pancreatitis is a rare disorder that frequently accompanies peripheral eosinophilia and/or eosinophilic gastroenteritis. Eosinophilic pancreatitis can mimic a pancreatic neoplasm by forming a pancreatic mass with focal pancreatic eosinophilic infiltration. Because eosinophilic pancreatitis responds well to steroid treatment, it is important to distinguish eosinophilic pancreatitis from pancreatic neoplasm. Thus, fine needle aspiration biopsy (FNAB) should be considered in patients with a pancreatic mass accompanied by peripheral eosinophilia and/or eosinophilic gastroenteritis. We describe a case of eosinophilic pancreatitis with annular pancreas that was diagnosed by FNAB. This is the first reported case of eosinophilic pancreatitis with annular pancreas diagnosed by FNAB.
Subject(s)
Humans , Biopsy , Biopsy, Fine-Needle , Enteritis , Eosinophilia , Eosinophils , Gastritis , Gastroenteritis , Pancreas , Pancreatic Diseases , Pancreatic Neoplasms , PancreatitisABSTRACT
Portal annular pancreas is one of the pancreatic fusion anomalies in which the uncinate process of the pancreas extends to fuse with the dorsal pancreas by encircling the portal vein or superior mesenteric vein. We report two consecutive patients with portal annular pancreas. The first case is a 71-year-old male patient who underwent a pancreaticoduodenectomy for intraductal papillary mucinous neoplasm in the head of pancreas. His preoperative computed tomography scan showed the suprasplenic type portal annular pancreas. The second case is a 74-year-old female patient who underwent a laparoscopic anterior radical antegrade modular pancreatosplenectomy (RAMPS) for pancreatic body cancer. In operative finding, portal confluence (superior mesenteric vein-splenic vein-portal vein) was encased with the uncinate process of pancreas in both cases. Therefore, they required pancreatic division at the pancreatic neck portion twice. During the postoperative period, grade B and A, respectively, postoperative pancreatic fistulas occurred and were controlled by conservative management. Surgeons need to know about this rare pancreatic condition prior to surgical intervention to avoid complications, and to provide patients with well-designed, case-specific pancreatic surgery.
Subject(s)
Aged , Female , Humans , Male , Adenocarcinoma, Mucinous/diagnosis , Mesenteric Veins/diagnostic imaging , Pancreas/abnormalities , Pancreatic Diseases/diagnosis , Pancreatic Fistula/etiology , Pancreatic Neoplasms/diagnosis , Pancreaticoduodenectomy/adverse effects , Portal Vein/diagnostic imaging , Splenic Vein/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
The annular pancreas in adults is a rare congenital anomaly that is detected after development of complications, such as gastric outlet obstruction, recurrent pancreatitis, and peptic ulcer. Duodenal bypass is the procedure of choice for treating duodenal obstruction caused by the annular pancreas in both children and adults. Duodenoduodenostomy is routinely performed in neonates and children. In adults, duodenojejunostomy or gastrojejunostomy are recommended, because the duodenum is less mobile. We report a case of annular pancreas in a 33-year-old male that was successfully treated with laparoscopic gastrojejunostomy.
Subject(s)
Adult , Child , Humans , Infant, Newborn , Male , Duodenal Obstruction , Duodenum , Gastric Bypass , Gastric Outlet Obstruction , Laparoscopy , Pancreas , Pancreatic Diseases , Pancreatitis , Peptic UlcerABSTRACT
Annular pancreas is a rare developmental anomaly where the head of the pancreas surrounds the second part of the duodenum like a ring. This may cause the duodenal constriction, obstruction, peptic ulcers and other complications. We saw a classic case of annular pancreas. The head of pancreas surrounded the second part of duodenum completely. However there was no narrowing of the duodenum. The case may be of importance for gastroenterologists, surgeons and radiologists.
El páncreas anular es una rara anomalía del desarrollo, donde la cabeza de este órgano rodea, como un anillo, la segunda parte del duodeno. Ésto puede causar constricción y obstrucción duodenal, úlceras pépticas y otras complicaciones. Reportamos un caso clásico de páncreas anular. La cabeza del páncreas rodeó la segunda parte del duodeno por completo. Sin embargo, no hubo una estenosis duodenal. Este caso puede ser de importancia para los gastroenterólogos, cirujanos y radiólogos.
Subject(s)
Humans , Middle Aged , Pancreas/abnormalities , Duodenum/abnormalitiesABSTRACT
Annular pancreas is a rare congenital anomaly that consists of a ring of pancreatic tissue partially or completely encircling the descending portion of the duodenum. Coexisting ampullary carcinoma in annular pancreas combined with anomaly of hepatic artery or bile duct are thought to be extremely rare. Two consecutive cases of ampullary carcinoma in annular pancreas with bile duct or hepatic artery anomaly are described. In addition, English literature reports of coexisting ampullary carcinoma in annular pancreas are summarized. Clinical symptoms of the two patients were jaundice and abdominal discomfort. The two ampullary cancers were early adenocarcinomas in the ampulla of Vater that were curatively treated by pylorus preserving pancreaticoduodenectomy. Ampullary carcinoma associated with annular pancreas is rare. Its combination with an additional biliary or hepatic artery anomaly make our cases extremely unique. Certain aberrant events in the overall stages of the development of the liver, bile duct, and pancreas may have occurred in these patients. Surgeons need to note preoperatively these possible associated anatomic variations.
Subject(s)
Humans , Adenocarcinoma , Ampulla of Vater , Anatomic Variation , Bile Ducts , Duodenum , Hepatic Artery , Jaundice , Liver , Pancreas , Pancreatic Diseases , Pancreaticoduodenectomy , PylorusABSTRACT
Objective: To study a congenital malformation of pancreas, the annular pancreas, and openings of pancreatic ducts. This abnormality can cause duodenal obstruction. Methods: The annular pancreas and duodenum of an 86-year-old Thai female cadaver was removed. The length and width of the annular pancreas were measured, as well as the internal diameter of the duodenum at the surrounded part and also the higher level. The openings of pancreatic duct were also carefully observed. Results: The second part of the duodenum was completely surrounded by the pancreatic tissue. The uncinate process extended over the anterior surface of the third part of the duodenum. The differences between the diameter of the duodenum at the surrounded part and at the higher level were 0.2 cm. there is no duodenal obstruction in this case. There were 2 openings of the pancreatic duct which opened to the second part of the duodenum. These ducts situated higher than the normal level, and were the primitive remains of the dorsal and ventral pancreatic buds. Conclusions: Not all the cases of the annular pancreas cause duodenal obstruction. In the cases that the pancreatic tissue loosely surrounds the duodenum, the diameters of the duodenum at the surrounding and at the slightly higher level are nearly the same. The pancreatic openings showed the primitive characters, i.e., there were 2 openings represented 2 origins of the pancreatic buds.
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La obstrucción intestinal duodenal es frecuente en el recién nacido como causa de oclusión, puede ser completa (atresia duodenal) secundaria a un trastorno de revacuolización de la luz intestinal o por una rotación irregular del páncreas hacia la derecha del duodeno. Presentamos a un recién nacido con edad gestacional de 35.4 semanas, conteo de Apgar de 8-8 puntos, que nace con signos de shock hipovolémico secundario a una anemia aguda por desgarro del corión, con una Encefalopatía Hipóxica Isquémica(EHI). Desarrolló posteriormente una intolerancia digestiva con abundante residuo gástrico, valorándose una oclusión intestinal incompleta alta, posiblemente por una estenosis duodenal. Se le realizan radiografías de abdomen simple de pie apoyándose la sospecha clínica por la presencia de imagen típica "en doble burbuja", se realizó laparotomía exploradora encontrando en el acto quirúrgico una Estenosis Duodenal secundaria a un Páncreas Anular. Es egresado a los 45 días de vida con buen peso corporal y reflujo gastroesofágico grado III como complicación. Actualmente se encuentra bajo seguimiento ambulatorio multidisciplinario y en franca evolución satisfactoria.
Duodenal intestinal obstruction is frequent in newborn as a cause of occlusion, it can be complete (duodenal atresia), secondary to a disorder of revacuolization of the intestinal lumen, or due to an irregular rotation of pancreas towards theright of duodenum. A newborn with a gestational age of 35.4 weeks, apgar score of 8.8 who was born with signs of hypovolemic shock secondary to an acute anemia caused by chorion tear with an Ischemic Hypoxic Encephalopathy, who subsequently deveoped a digestive intolerance with abundant gastric residue. An incomplete intestinal occluson was assessed - possibly as a result of a duodenal stenosis - simple abdominal X - rays was performed, supporting clinical suspicion because of the presence of a typical image in "double bubble". An exploratory laparatomy was carried out, finding in surgery a Duodenal Stenosis secondary to an annular Pancreas. The patient was discharged from the hospital 45 days after being born with a good weight and as complication a gastroesophageal reflux of third degreee. Currently the patient undergoes ambulatory-multidisciplinary follow-up, and is making a satisfactory progress.
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Objective To evaluate the imaging findings of the annular pancreas in newborn and the diagnostic value.Methods Clinical data,X-ray and CT features of annular pancreas in 7 cases of newborn were retrospectively analyzed,and 6 cases were confirmed by operations.Results Abdominal erect position plain films were performed in six patients and showed typical "double bubble sign" without distal gas in 5 cases,with a little gas in 1 case.Seven patients underwent upper gastrointestinal contrast studies and showed stenosis of the descending duodenum like "the thin striation",and contrast agent passed with difficulty.There were soft tissue shadows encircling the descending duodenum in 4 cases on CT plain scans,in which 3 cases showed stenosis of the descending duodenum like "the mouse tail",and the soft tissue shadows obviously enhanced the same as enhanced pancreas on contrast-enhanced CT scans.Conclusion The annular pancreas in newborn are of characteristics at imageology.
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Annular pancreas is a rarely found gastrointestinal tract malformation, and is frequently associated with Down syndrome. Endocardial cushion defect is a type of congenital heart disease, commonly also related to Down syndrome. However, a combination of endocardial cushion defect with annular pancreas has not been reported previously. We recently experienced such a case in 2 month old boy. Moreover Down syndrome was excluded through physical examination and a chromosomal study. We think it difficult to obtain a complete explanation for this condition through the currently known pathogenesis of annular pancreas and endocardial cushion defect.
Subject(s)
Humans , Infant , Male , Down Syndrome , Endocardial Cushion Defects , Endocardial Cushions , Gastrointestinal Tract , Heart Defects, Congenital , Pancreas , Physical ExaminationABSTRACT
An annular pancreas is a rare congenital variant of the pancreatic anatomy, which may cause symptoms of gastric outlet obstruction and recurrent pancreatitis, and is often hard to diagnose before operation. The case of an annular pancreas with intermittent abdominal pain in a 38-year-old alcoholic man is described. A duodenal obstruction with consecutive ulcers was the clinical manifestation in this patient. The annular pancreas was diagnosed by using hypertonic duodenography followed by pancreatic angiography. The duodenoscopy revealed stenosis of the pancreas. A duodeno-duodenostomy relieved the symptoms. The patient had an uneventful recovery following a operation.