Obstrucción duodenal por páncreas anular / Duodenal obstructon due to anular pancreas

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.

Malformações congênitas do pâncreas: um caso clínico / Congenital pancreas malformations: a clinical case report

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.

A Classic Case of Annular Pancreas and its Clinical Implications / Un Caso Clásico de Páncreas Anular y sus Implicaciones Clínicas

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.

Páncreas anular: a propósito de un caso / Annular pancreas: report of a case

El Páncreas Anular es una de las malformaciones congénitas extrínsecas más frecuentes de durante el desarrollo del intestino cefálico, quecausa una obstrucción parcial o completa en la segunda porción del duodeno. Presentamos el caso de una lactante de cuatro semanas deedad, transferida de la ciudad de Oruro al Hospital del Niño de la ciudad de La Paz, por emesis incoercible y bajo peso; estudios radiológicossugieren cuadro duodenal obstructivo, evidenciándose el mismo en el acto quirúrgico, originado por páncreas anular...

The annular pancreas is one of the most frequent congenital malformations that occur during the development of the intestine causing a partial or complete obstruction of the second portion of the duodenum. We present the case of a four weeks old baby girl who was transferred from the city of Oruro to the Hospital del Niño (Children’s Hospital) in La Paz due to incontrollable vomiting and low weight. The abdominal x-ray suggested duodenal obstruction that was evident on surgery, caused by annular pancreas.

Estenosis duodenal por páncreas anular. Presentación de un caso esporádico / Duodenal stenosis for annular páncreas. A sporadic case presentation

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.