Annular pancreas

Definition

An annular pancreas is a ring of pancreatic tissue that encircles the duodenum (the first part of the small intestine). Normally, the pancreas sits next to, but does not surround, the duodenum.

Causes

Annular pancreas is a congenital defect, which means it is present at birth. Symptoms occur when the ring of pancreas squeezes and narrows the small intestine so that food cannot pass easily or at all.

Newborns may have symptoms of complete blockage of the intestine. However, up to half of people with this condition do not have symptoms until adulthood. There are also cases that are not detected because the symptoms are mild.

Conditions that may be associated with annular pancreas include:

• Down syndrome
• Excess amniotic fluid during pregnancy (polyhydramnios)
• Other congenital gastrointestinal problems
• Pancreatitis

Symptoms

Newborns may not tolerate feedings. They may spit up more than normal, not drink enough breast milk or formula, and cry.

Adult symptoms may include:

• Fullness after eating
• Nausea or vomiting

Exams and Tests

Tests include:

• Abdominal ultrasound
• Abdominal x-ray
• CT scan
• Upper GI and small bowel series

Treatment

Surgical bypass of the blocked part of the duodenum is the usual treatment for this disorder.

Outlook (Prognosis)

The outcome is usually good with surgery. Adults with an annular pancreas are at increased risk for pancreatic or biliary tract cancer.

Possible Complications

• Obstructive jaundice
• Pancreatic cancer
• Pancreatitis (inflammation of the pancreas)
• Peptic ulcer
• Perforation (tearing a hole) of the intestine due to obstruction
• Peritonitis

When to Contact a Medical Professional

Call for an appointment with your health care provider if you or your child has any symptoms of annular pancreas.

References

Semrin MG, Russo MA. Anatomy, histology, embryology, and developmental anomalies of the stomach and duodenum. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran's Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 45.

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