Annular Pancreas in Adults. A Case Report

Abstract

Introduction. Annular pancreas is a rare congenital anomaly detected after the development of complications or as an incidental finding. Its diagnosis and treatment are controversial.

Case presentation. A 44-year-old woman with chronic episodes of mild epigastric pain, nausea and emesis, with increasing frequency over the past two months. An abdominal ultrasound showed a distended gallbladder without stones, and dilated extrahepatic bile ducts. An endoscopic retrograde cholangiopancreatography was performed, revealing a circumferential pancreatic duct in the head of the pancreas surrounding the second part of the duodenum. By injecting contrast medium through the major papilla, its drainage was observed through a second, adjacent pore. Suspecting annular pancreas, magnetic resonance cholangiopancreatography was performed, showing a complete annular pancreatic duct. In the presence of recurrent symptoms of abdominal pain, the patient was referred to hepatobiliary surgery for definitive surgical management.

Conclusions. Annular pancreas is a diagnosis to be considered in adults in case of epigastric pain associated with non-specific symptoms. Advances in imaging methods make its diagnosis timely. Despite the lack of guidelines on treatment, this must be individualized on a case-by-case basis.