Asian Journal of Research in Surgery

Annular Pancreas with Intestinal Malrotation in 12 Years’ Girl: A Rare Case Report

S. N. Jatal *

Jatal Hospital and Research Centre, Latur, India.

Sudhir Jatal

Jatal Hospital and Research Centre, Latur, Tata Hospital, Mumbai, India.

Supriya Jatal

MGM Hospital & College, Navi Mumbai, India.

Ganesh Swami

V. D. Govt. Medical College, Latur, India.

*Author to whom correspondence should be addressed.

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Abstract

Annular pancreas is a congenital anomaly characterized by the presence of a ring of pancreatic tissue that partially or completely encircles the second part of the duodenum. This condition results from the failure of the vertical pancreatic bud to rotate properly, leading to its elongation and encircling of the upper section of the duodenum.

The first description of annular pancreas was made by Tiedemann in 1818, and the term "Annular pancreas" was coined by Ecker in 1982. In the normal development of the pancreas, the dorsal and ventral pancreatic buds fuse during the first 4-8 weeks of embryonic life. In cases of annular pancreas, the ventral bud fails to rotate as it should, causing it to elongate and encircle the upper part of the duodenum. This condition can affect individuals from neonates to the elderly, making it challenging to diagnose.

Diagnosing annular pancreas can be accomplished through various methods, including preoperative procedures such as upper GI endoscopy, Barium meal follow-through, CT and MRI scans, ERCP (endoscopic retrograde cholangiopancreatography), and endoscopic ultrasonography (EUS). In approximately 40% of cases, surgical intervention is necessary to confirm the diagnosis.

We present a rare case of annular pancreas in a 12-year-old girl who also had intestinal malrotation. She was experiencing frequent episodes of vomiting. Her diagnosis was confirmed through a Barium meal follow-through, which revealed a typical "Double bubble" sign. She underwent a gastrojejunostomy and a modified Ladd's operative procedure to address the condition.

Keywords: Annular pancreas, intestinal malrotation, gastro-jejunostomy

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References

Alahmadi R, Almuhammadi S. Annular pancreas: A cause of gastric outlet obstruction in a 20-year-old patient. Am J Case Rep. 2014 Oct 9;15:437- 40. Doi: 10.12659/AJCR.89104 PMID: 25300027; PMCID: PMC4206480.

Shabaka A, Mateos-Sánchez P, Amador-Borrero B, Antolín J, Cigüenza R. Symptomatic annular pancreas in an adult: An unusual cause of abdominal pain. Dig Med Res. 2019;2:3.

Husaric Edin, Husarić Edin, Hotić Nešad, Halilbašić Amir, Rahmanović Emir, Suljendić Sanimir. Annular pancreas with duodenal stenosis and intestinal malrotation in two years girl: A case report. Paediatrics Today 2014;10(1):47- 50. DOI: 10.5457/p2005-114.88

Shashikant Kulgod, Amit Shivshankar Ammanag. A Case of Malrotation of Mid Gut with Incidental Finding of Annular Pancreas, International Journal of Anatomy, Radiology and Surgery. 2017 Apr;6(2):SC01- SC02.

Urayama S, Kozarek R, Ball T, Brandabur J, Traverso L, Ryan J, et al. Presentation and treatment of annular pancreas in an adult population. Am J Gastroenterol. 1995;90(6):995-9.

Suk-Bae Moon, Annular pancreas in an 11-year-old girl: A case report, International Medical Case Report Journal, IMCRJ (dovepress.com).

Makkadafi M, Fauzi AR, Wandita S, et al. Outcomes and survival of infants with congenital duodenal obstruction following Kimura procedure with post-anastomosis jejunostomy feeding tube. BMC Gastroenterol. 2021;21:100.

Avilable:https://doi.org/10.1186/s12876-021-01679-8

Selvaraj B, Senthil Kumaran K, Sekar GP. Annular pancreas – a case report and review of the literature. International Journal of Recent Trends in Science and Technology. January to March 2020; 10(1):70-74 Avilable:http://www.statperson.com

Ayushi Vig, Kirtikumar J Rathod, Neeraj Gupta, Kamlesh Kumari, Arvind Sinha/ Laparoscopic treatment of annular pancreas in a neonate, Journal of Pediatric Surgery Case Reports Avilable:https://doi.org/10.1016/j.epsc.2021.101914

Niharika Prasad, Sanjay M Khaladk. Partial malrotation with incomplete annular pancreas, midgut volvulus and Superior mesenteric artery syndrome Avilable:https://www.eurorad.org/case/17089