The annular pancreas as a cause of surgical conditions in adults

Abstract

Background. Annular pancreas (AP) is an embryonal pathology, characterized by the presence of a ring of pancreatic tissue that surrounds the descending duodenum, and is manifested by neonatal acute duodenal obstruction. In adults AP is diagnosed much rarer, whereas symptoms are latent and vary greatly. Material and methods. Three patients were treated with complicated AP, 2 – with symptoms of refractory postbulbar ulcer, duodenal stenosis, and prolonged ulcer history. In both cases AP, as a cause of condition, was detected only intraoperative. In the third patient, admitted for adenocarcinoma of the pancreatic head, AP was established by preoperative abdominal CT.Purpose. To identify clinical characteristics and treatment strategy in adult patients with complicated AP. Material and methods. Three patients were treated with complicated AP, 2 – with symptoms of refractory postbulbar ulcer, duodenal stenosis, and prolonged ulcer history. In both cases AP, as a cause of condition, was detected only intraoperative. In the third patient, admitted for adenocarcinoma of the pancreatic head, AP was established by preoperative abdominal CT. Results. All patients had an uneventful postoperative evolution. Patients after surgeries for duodenal ulcer are asymptomatic clinical and endoscopic during 5 and 3 years respectively. Etiopathogenetic correlation between pre-existing AP and pancreatic adenocarcinoma, which may be suspected in the third patient, is questionable. Conclusions. In the era of effective antiulcerous therapy, the presence of refractory postbulbar ulcer with long history of disease, may suggest the AP. Modern imaging studies allow early diagnosis of condition and individualization of surgical management.