• Onur Yildirim Radiology Department, Memorial Sloan Kettering Cancer Center, New York, US; Radiology Department, Cerrahpasa Hospital, Istanbul, Turkey
  • Mai Al Khatalin Prince Hussein Hospital, AL baqah, Jordan
  • Emin ME Upmc shadyside Pittsburgh, PA, USA
Ключевые слова: Annular pancreas, duodenal obstruction, congenital abnormality, duodenojejunostomy


Background. Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue surrounding the descending portion of the duodenum. It is thought to originate from the incomplete rotation of the ventral pancreatic bud.
Objective. To present a case description of a 27-year-old female with duodenal obstruction due to annular pancreas

Material and methods. The clinical manifestations, laboratory and instrumental findings of a female patient.
Results. We report the case of a 27-year-old female with 3 months history of upper abdominal pain, nausea, postprandial fullness, and recurrent vomiting. Physical examination revealed nothing except for the thin-built body. Routine biochemical and hematological investigations were within normal limits. The patient's standing direct abdominal graphy revealed air-fluid level and dilated both stomach and the first part of duodenum. Upper gastrointestinal series showed circumferential extrinsic compression on the 2nd portion of the duodenum. Abdominal computerized tomography (CT) and ultrasonography (USG) revealed a ring of pancreatic tissue encircling the second part of the duodenum. We present the clinical presentation, treatment plan which is performed through a duodenojejunostomy bypass procedure, and follow-up of the patient.
Conclusions. Annular pancreas is associated with duodenal atresia. It usually appears in infancy but might become clinically evident in adulthood with obstruction of the duodenum. The symptoms include constipation, nausea, and vomiting. and usually arise due to obstruction to gastric emptying. In order to confirm the presence of annular pancreas, abdominal CT scans with high resolution and angiography protocols as well as magnetic resonance imaging are helpful.


Thukral C, Steven D Freedman, SD. Annular pancreas. UpToDate. [Internet]. 2021. Available from:

Norton KI, Tenreiro R, Rabinowitz JG. Sonographic demonstration of annular pancreas and a distal duodenal diaphragm in a newborn. Pediatr Radiol. 1992;22(1):66-67.

De Ugarte DA, Dutson EP, Hiyama DT. Annular pancreas in the adult: management with laparoscopic gastrojejunostomy. Am Surg. 2006;72(1):71-73.

Traubici J. The double bubble sign. Radiology. 2001;220(2):463-464.

Tiedemann F. Ueber die Verfchiedenheiten des Ausführungsgangs der Bauchfpeicheldrüfe bei dem Menfchen und den Säugethieren. In: Meckel JF, editor. Deutsches Archiv für die Physiologie. Berlin;1818. p. 403-411. (German).

Ecker A. Bildungsfehier des Pankreas und des Herzens. Z. Art. Med. 1862;14:354. (German).

Lee PC, Lebnethal E. Prenatal and postnatal development of the human exocrine pancreas. In: Go VL, DiMagno EP, Gardner JD, editors. The Pancreas: Pathology, pathobiology and disease. 2nd ed. New York: Raven Press; 1993. p. 57-73.

Miyazawa M, Muto A, Sato M, Koyama K, Endo H, Ashino Y. A case of annular pancreas in a male adult. Fukushima J Med Sci. 2004;50(2):75-81.

Siew JX, Yap TL, Phua KB, Kader A, Fortier MV, Ong C. Annular pancreas: a rare cause of upper gastrointestinal bleeding in a child. J Pediatr Gastroenterol Nutr. 2013;57(6):e34-6.

Cheng L, Tian F, Zhao T, Pang Y, Luo Z, Ren J. Annular pancreas concurrent with pancreaticobiliary maljunction presented with symptoms until adult age: case report with comparative data on pediatric cases. BMC Gastroenterol. 2013;13:153.

Johnston DW. Annular pancreas: a new classification and clinical observations. Can J Surg. 1978;21(3):241-244.

Zheng HM, Cai XJ, Shen LG, Finley R. Surgical treatment of annular pancreas in adults: a report. Chin Med J. 2007;120(8):724-725.

Foo FJ, Gill U, Verbeke CS, Guthrie JA, Menon KV. Ampullary carcinoma associated with an annular pancreas. JOP. 2007;8(1):50-54.

Urayama S, Kozarek R, Ball T, Brandabur J, Traverso L, Ryan J, Wechter D. Presentation and treatment of annular pancreas in an adult population. Am J Gastroenterol. 1995;90(6):995-999.

De Ugarte DA, Dutson EP, Hiyama DT. Annular pancreas in the adult: management with laparoscopic gastrojejunostomy. Am Surg. 2006;72(1):71-73.

Как цитировать
Yildirim O, Khatalin MA, ME E. A RARE CASE OF A 27-YEAR-OLD FEMALE PRESENTED WITH DUODENAL OBSTRUCTION DUE TO ANNULAR PANCREAS. journalHandG [Интернет]. 7 июнь 2022 г. [цитируется по 29 ноябрь 2022 г.];6(1):89-2. доступно на:
Случай из практики