Korean J Gastroenterol.  2022 Apr;79(4):182-186. 10.4166/kjg.2022.012.

Annular Pancreas: A Rare Cause of Upper Gastrointestinal Bleeding in Adults

Affiliations
  • 1Division of Gastroenterology, Department of Internal Medicine, Seoul Medical Center, Seoul, Korea

Abstract

Annular pancreas is a rare congenital anomaly in which a thin band of pancreatic tissue partially or completely surrounds the duodenum. It is challenging to diagnose due to its variable clinical presentation. Approximately two-thirds of patients have no symptoms in their lifetime, and most symptomatic cases are seen in neonates and infants. Symptomatic adult patients present with upper gastrointestinal symptoms, such as epigastric pain, vomiting, and postprandial fullness associated with gastric outlet obstruction. Complications associated with annular pancreas include peptic ulcer disease, pancreatitis, pancreatic head carcinoma, and biliary obstruction. Annular pancreas is also a rare cause of upper gastrointestinal bleeding in adults, but it should be considered as one of the differential diagnoses in patients presenting with a peptic ulcer and duodenal stricture. Here, we report the case of a 60-year-old man who presented with melena and was subsequently diagnosed with an annular pancreas.

Keyword

Annular pancreas; Duodenum; Melena; Peptic ulcer; Gastric outlet obstruction

Figure

  • Fig. 1 (A, B) Endoscopy shows an active ulcer in the gastric antrum and stricture of the pylorus. (C) Initial abdominal computed tomography shows diffuse thickening of the stomach wall (arrows).

  • Fig. 2 Initial abdominal computed tomography shows an abrupt narrowing of the duodenal bulb with a 1.9-cm lobular enhancing lesion (white arrows). (A-C) Axial view. (D) Coronal view.

  • Fig. 3 (A, B) Follow-up endoscopy performed 7 days later demonstrates an improvement in the gastric ulcer, although the pyloric stenosis is still present. (C, D) Pediatric endoscopy shows normal lumen of the second part of the duodenum and narrowing of the duodenal bulb.

  • Fig. 4 Follow-up endoscopy performed 6 months after surgery shows (A, B) ulcer scars and (C) anastomosis site in the antrum.


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