Partial annular pancreas in a 12-year-old girl

Abstract

Introduction. Annular pancreas is a rare congenital anomaly in which a band of pancreatic tissue, in continuity with pancreatic head, completely or incompletely surrounds the descending part of duodenum. An abnormal pancreatic development can cause complete annular pancreas, partial annular pancreas and pancreas divisum. Complete annular pancreas is diagnosed in newborns, while the diagnosis of partial annular pancreas is more frequently established in adults. The most reliable diagnostic methods are computed tomography and magnetic resonance cholangiopancreatography. The anomaly is treated surgically, using bypass procedures. Case report. A 12-year-old girl presented malnourished, with occasional feeding problems, vomiting, heartburn and pain from infancy. Upper gastrointestinal series showed extremely dilated stomach, the first and the second part of the duodenum. Endoscopic exam revealed the dilated stomach, pilorus, the first and the second part of the duodenum with retained contrast, while the entrance of the endoscope into the third part of duodenum was not possible. Computed tomography showed pancreatic tissue encircling the second part of duodenum and the characteristic "crocodile jaw" sign. Roux-en-Y duodeno-jejunostomy was performed as a bypass procedure. Conclusion. Complete annular pancreas is a well known and easily diagnosed anomaly in newborns. Partial annular pancreas is often poorly recognized, especially in patients who do not present with marked duodenal obstruction. Unrevealed, it causes chronic problems in food intake, with possible serious complications. Although very rare condition in pediatric population, partial annular pancreas should be taken into consideration in unclear cases of chronic poor oral food intake and vomiting.