Annular Pancreas: Clinical Presentation and Management
Summary
Annular pancreas is a congenital anomaly in which pancreatic tissue forms a ring around the second portion of the duodenum. Its incidence is estimated at approximately 1 in 20 000 live births but may remain undetected until adulthood. In neonates, complete annular pancreas often presents with duodenal obstruction, bilious vomiting and failure to thrive, whereas adults may experience non-specific symptoms such as postprandial abdominal pain, nausea or recurrent pancreatitis. Modern imaging modalities—including contrast-enhanced computed tomography, magnetic resonance cholangiopancreatography and upper gastrointestinal series—facilitate preoperative diagnosis, although some cases are only identified intraoperatively. Symptomatic management relies primarily on surgical bypass of the obstructing ring, with techniques such as duodenoduodenostomy, duodenojejunostomy or gastrojejunostomy tailored to the patient’s anatomy. Endoscopic interventions may play a supplementary role in selected cases. Long-term follow up is recommended to monitor for associated anomalies, including pancreaticobiliary maljunction, and rare complications such as annular pancreatic carcinoma.
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Annular Pancreas: Clinical Presentation and Management publication trend
The graph below shows the total number of articles in annular pancreas: clinical presentation and management across all publications each year (not limited to Nature Index journals).
Technical terms
Annular pancreas: Congenital ring of pancreatic tissue encircling the duodenum, causing variable obstruction.
Duodenoduodenostomy: Surgical anastomosis connecting proximal and distal segments of the duodenum to bypass an obstruction.
Duodenojejunostomy: Creation of an anastomosis between the duodenum and jejunum to divert luminal flow.
Gastrojejunostomy: Bypass operation linking the stomach to the jejunum, circumventing duodenal obstruction.
Magnetic resonance cholangiopancreatography (MRCP): Non-invasive MRI technique visualising the biliary and pancreatic ductal systems.
Endoscopic retrograde cholangiopancreatography (ERCP): Endoscopic imaging and therapeutic procedure for the biliary and pancreatic ducts.
HNF1B: Hepatocyte nuclear factor-1 beta, a transcription factor involved in pancreatic development and associated with congenital anomalies when dysregulated.
References
- Overdosage of HNF1B Gene Associated With Annular Pancreas Detected in Neonate Patients With 17q12 Duplication. Frontiers in Genetics (2021).
- Annular pancreas concurrent with pancreaticobiliary maljunction presented with symptoms until adult age: case report with comparative data on pediatric cases. BMC Gastroenterology (2013).
- Annular pancreas causing pyloric stenosis in a 66-year-old patient treated with gastrojejunostomy: a case report. Journal of Surgical Case Reports (2021).
- Effective surgical management of gastric outlet obstruction symptoms caused by annular pancreas in an adult female: A case report. International Journal of Surgery Case Reports (2024).
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