-
Endoscopy Dec 2023
Topics: Humans; Pancreas Divisum; Pancreas; Pancreatic Diseases; Cholangiopancreatography, Endoscopic Retrograde; Pancreatic Ducts
PubMed: 36958350
DOI: 10.1055/a-2032-3462 -
JGH Open : An Open Access Journal of... Oct 2020Annular pancreas is a rare entity. It clinically presents with intestinal obstruction. We present a case of a young female with incomplete annular pancreas presented...
Annular pancreas is a rare entity. It clinically presents with intestinal obstruction. We present a case of a young female with incomplete annular pancreas presented with recurrent acute pancreatitis.
PubMed: 33102782
DOI: 10.1002/jgh3.12391 -
Medicine Dec 2017Portal annular pancreas is a rare anatomic variation, where the uncinated process of the pancreas connects with the dorsal pancreas and the pancreas tissue encases the...
Radical antegrade modular pancreatosplenectomy for adenocarcinomaof the body of the pancreas in a patient with portal annular pancreas, aberrant hepatic artery, and absence of the celiac trunk: A case report.
RATIONALE
Portal annular pancreas is a rare anatomic variation, where the uncinated process of the pancreas connects with the dorsal pancreas and the pancreas tissue encases the portal vein (PV), superior mesenteric vein (SMV) or splenic vein (SV). Malignancies are quite uncommon in the patients, who have an annular pancreas especially portal annular pancreas. Ectopic common hepatic artery and absence of the celiac trunk (CT) are the other infrequent abnormalities.
PATIENT CONCERNS
A 74-year-old man suffered from upper abdominal and back pain.
DIAGNOSES AND INTERVENTIONS
Contrast enhanced computed tomography indicated a low-density mass in the body of the pancreas. Pathological report showed adenocarcinoma of the body of pancreas after radical antegrade modular pancreatosplenectomy (RAMPS).
OUTCOMES
In the operation, we found the superior vein and portal vein was surrounded by the pancreatic tissue. The left gastric artery and splenic artery originated respectively from abdominal aorta, and celiac trunk was not viewed. In addition, the common hepatic artery was a branch from the superior mesenteric artery.
LESSONS
In general, this is a novel clinical case of pancreatic carcinoma happening in the portal annular pancreas which was accompanied with aberrant hepatic artery and absence of the celiac trunk at the same time. Confronted with the pancreatic neoplasms, the possibility of coexistent annular pancreas and arterial variations should be considered.
Topics: Adenocarcinoma; Aged; Celiac Artery; Contrast Media; Hepatic Artery; Humans; Male; Pancreas; Pancreatectomy; Pancreatic Neoplasms; Portal Vein; Splenectomy; Tomography, X-Ray Computed
PubMed: 29310347
DOI: 10.1097/MD.0000000000008738 -
Zhejiang Da Xue Xue Bao. Yi Xue Ban =... Jul 2019To analyze clinical manifestations, diagnosis and treatment of annular pancreas in neonates.
OBJECTIVE
To analyze clinical manifestations, diagnosis and treatment of annular pancreas in neonates.
METHODS
Clinical data of 114 neonates with annular pancreas admitted in the Children's Hospital of Zhejiang University from January 2009 to December 2018 were reviewed. The demographic parameters (gestational age, birth weight), clinical manifestations, onset time, results of antenatal examination, associated anomalies, radiological findings, operations, postoperative complications were analyzed.
RESULTS
One hundred and two cases were examined by abdominal echography, in which 68 cases showed duodenal obstruction, 4 cases showed annular pancreas. Plain abdomen X-ray examination performed in 113 cases before operation, 76 cases presented double-bubble sign, 12 cases presented single-bubble sign and 5 cases had high-position intestinal obstruction. Upper gastrointestinal radiography (UGI) was performed in 103 cases, which suggested duodenal obstruction in 102 cases. Operations were performed in all cases, of which 69 cases were operated under laparoscopy including 1 case converted to open laparotomy. The mean fasting time after surgery was (7.8±2.7) d, and the mean length of hospital stay was (16.9±10.1) d. Five patients had postoperative complications. The incidence of postoperative complications in antenatal abnormal group was lower than that in the antenatal non-abnormal group (<0.05); the average fasting time in laparoendscopic surgery group was shorter than that in traditional laparotomy group (<0.05).
CONCLUSIONS
Neonates with recurrent vomiting early after birth should be highly suspected to have annular pancreas. The fetal chromosome examination should be performed with abnormal antenatal screening. Surgery is the only effective way to diagnose and treat annular pancreas, and laparoscopic surgery could be the first choice for experienced doctors.
Topics: Duodenal Obstruction; Humans; Infant, Newborn; Laparoscopy; Pancreas; Pancreatic Diseases; Retrospective Studies
PubMed: 31901020
DOI: 10.3785/j.issn.1008-9292.2019.10.03 -
Radiology Case Reports Mar 2023Annular pancreas is an uncommon congenital anomaly which is a rare cause of congenital duodenal obstruction. It is normally identified during the neonatal period, but...
Annular pancreas is an uncommon congenital anomaly which is a rare cause of congenital duodenal obstruction. It is normally identified during the neonatal period, but may also be identified in adolescence or adulthood. This diagnosis is often overlooked in adult patients who present with symptoms suggestive of duodenal obstruction. We present a case of AP detected in a 23-year-old man, with complaints of continuous vomiting and abdominal discomfort over the last 6 months. An upper gastrointestinal study revealed a constricted second part of the duodenum. A computed tomography scan revealed a complete ring of pancreatic tissue around the second part of the duodenum. Diagnostic and therapeutic surgery decompresses the external obstruction. The patient had an early post-operative activation. No specific guidelines and protocols exist about the management of such cases. Given the rarity of this congenital anomaly, presenting with chronic partial duodenal obstruction, and its successful surgical treatment, have prompted us to report the case along with a brief review of literature about the subject.
PubMed: 36747589
DOI: 10.1016/j.radcr.2022.11.083 -
Pancreas Oct 2014Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the... (Review)
Review
Portal annular pancreas (PAP) is an asymptomatic congenital pancreas anomaly, in which portal and/or mesenteric veins are encased by pancreas tissue. The aim of the study was to determine the role of PAP in pancreatic surgery as well as its management and potential complication, specifically, postoperative pancreatic fistula (POPF).On the basis of a case report, the MEDLINE and ISI Web of Science databases were systematically reviewed up to September 2012. All articles describing a case of PAP were considered.In summary, 21 studies with 59 cases were included. The overall prevalence of PAP was 2.4% and the patients' mean (SD) age was 55.9 (16.2) years. The POPF rate in patients with PAP (12 pancreaticoduodenectomies and 3 distal pancreatectomies) was 46.7% (in accordance with the definition of the International Study Group of Pancreatic Surgery).Portal annular pancreas is a quite unattended pancreatic variant with high prevalence and therefore still remains a clinical challenge to avoid postoperative complications. To decrease the risk for POPF, attentive preoperative diagnostics should also focus on PAP. In pancreaticoduodenectomy, a shift of the resection plane to the pancreas tail should be considered; in extensive pancreatectomy, coverage of the pancreatic remnant by the falciform ligament could be a treatment option.
Topics: Adrenal Gland Neoplasms; Delayed Diagnosis; Disease Management; Female; Humans; Incidental Findings; Infant, Newborn; Male; Middle Aged; Pancreas; Pancreatectomy; Pancreatic Diseases; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications; Prevalence; Sex Distribution
PubMed: 25207658
DOI: 10.1097/MPA.0000000000000186 -
Prenatal Diagnosis Oct 2020To retrospectively analyze the imaging findings of fetal intestinal obstruction diagnosed by MRI and compare with postnatal surgery findings.
OBJECTIVE
To retrospectively analyze the imaging findings of fetal intestinal obstruction diagnosed by MRI and compare with postnatal surgery findings.
METHODS
MRI data of 3346 pregnant women were retrospectively analyzed; we found 47 cases of suspected fetal small intestinal obstruction. Twenty-nine underwent postnatal surgery.
RESULTS
We identified one case of jejunal obstruction secondary to perforation, five annular pancreas, 10 duodenal stenoses, four jejunal stenoses, five jejunal atresias, two ileal atresias, four intestinal volvulus, and four intestinal malrotations. We further found four cases of duodenal stenosis with intestinal malrotation (two cases also showed volvulus). On fetal MRI, annular pancreas and duodenal obstruction manifested as a "double bubble." Jejunal stenosis appeared as a "triple bubble." Jejunal and ileal atresia mainly manifested as proximal dilatation with high signal on T1WI. Intestinal volvulus showed a sausage-like intestinal distortion and mixed signals on T1WI and DWI sequences. Intestinal malrotations were characterized as abnormal duodenal morphology. We missed two malrotations; one jejunal obstruction was misdiagnosed.
CONCLUSION
Prenatal MRI can accurately determine the degree of intestinal obstruction and help qualitatively diagnose its possible etiology according to changes in MRI signals in multiple sequences, providing guidance for prenatal counseling.
Topics: Fetal Diseases; Humans; Intestinal Obstruction; Intestinal Volvulus; Magnetic Resonance Imaging; Retrospective Studies
PubMed: 32594545
DOI: 10.1002/pd.5779 -
Radiology Case Reports Nov 2022Our purpose is to illustrate the radiological aspects of the annular pancreas as an etiology of duodenal obstruction in infants. We report the case of a 4-month-old...
Our purpose is to illustrate the radiological aspects of the annular pancreas as an etiology of duodenal obstruction in infants. We report the case of a 4-month-old girl, who was admitted to our department with postprandial vomiting evolving since birth. The initial examination found a severely dehydrated patient. Abdominal ultrasound showed gross dilatation of the stomach and duodenum, it also showed pancreatic tissue surrounding the duodenum, suggesting a diagnosis of annular pancreas as the cause of the duodenal obstruction. Post-contrast abdominal CT showed the gastric and duodenal dilatation, and a ring of pancreatic tissue surrounding uncompletly the second portion of the duodenum. The patient underwent a bypass surgery which consisted in a duodeno-duodenostomy with simple post-operative follow-up and no recurrence of digestive symptoms. Annular pancreas is a rare pathology to be sought in neonatal obstruction. A good knowledge of radiological semiology is essential for a good diagnostic approach. However, surgery is the only effective way to diagnose and treat this pathology.
PubMed: 36188077
DOI: 10.1016/j.radcr.2022.08.063 -
Pediatric Surgery International Mar 2022We aimed to evaluate possible positive and negative effects of postoperative use of transanastomotic feeding tube (TAFT) in neonates operated for congenital duodenal...
PURPOSE
We aimed to evaluate possible positive and negative effects of postoperative use of transanastomotic feeding tube (TAFT) in neonates operated for congenital duodenal obstruction (CDO).
METHODS
This is a retrospective study reviewing medical records of neonates operated for CDO during 2003-2020 and comparing postoperative feeding outcomes and complications in patients with and without TAFT. Approval from the hospital's data protection officer was obtained.
RESULTS
One hundred patients, 59% girls, were included, and 37% received TAFT. Mean birth weight and gestational age were 2628 (675.1) grams and 36.6 (2.4) weeks, respectively. Furthermore, 45% had no other malformations, and 36% had Down syndrome. Patient demographics were similar for TAFT and not-TAFT patients, except that not-TAFT neonates weighed median 335 g less (p = 0.013). The TAFT group got parenteral nutrition 2 days shorter (p < 0.001) and started enteral feeds 1.5 days earlier (p < 0.001) than the not-TAFT group. Fewer neonates with TAFT got a central venous catheter [65 vs 89%, (p = 0.008)]. In the TAFT group, 67% were breast fed at discharge compared to 49% in the not-TAFT group (p = 0.096).
CONCLUSION
Neonates with TAFT had earlier first enteral feed, fewer days with parenteral nutrition and fewer placements of central venous catheters.
Topics: Duodenal Obstruction; Enteral Nutrition; Female; Humans; Infant, Newborn; Intubation, Gastrointestinal; Male; Parenteral Nutrition; Retrospective Studies
PubMed: 34910223
DOI: 10.1007/s00383-021-05053-3 -
Physiology International Mar 2023According to current protocol, the separation of pancreatic head and body is performed at the level of superior mesenteric vein (SMV). Previous data indicate that the...
PURPOSE
According to current protocol, the separation of pancreatic head and body is performed at the level of superior mesenteric vein (SMV). Previous data indicate that the resection plane should be modified in portal annular pancreas. We presumed that the optimal line of pancreatic resections could also be different in other cases. Our aim is to simulate pancreatic resections in different planes and find the optimal resection line with the minimum number of cut vessels.
MAIN METHODS
25 abdominal vascular corrosion casts were prepared, the aorta and the portal vein were cannulated. CT scans were taken on the casts, and specific planes were reconstructed simulating different resection lines. The total amount of cross sections of vessels were calculated in the different planes.
RESULTS
In our series, the optimal plane is the SMV in 11/25, 2 cm left in 10/25, 1 cm left in 4/25, 1 cm right in 1/25 and 2 cm right in none of our cases. The group of left sided extension contain more than half of the cases. With left sided resections, the cut surface of the vessels may be lowered to even 29% compared to the SMV plane.
CONCLUSION
Our study revealed that pancreatic resections should be extended to the left side of the SMV in more than half of our cases. Therefore, the resection plane should be determined by preoperative imaging methods. Using DICOM viewer with multiplanar reconstruction, the resection planes can be simulated in clinical practice, which would reduce the risk of postoperative bleeding.
Topics: Humans; Pancreaticoduodenectomy; Pancreatic Neoplasms; Pancreas; Pancreatic Diseases
PubMed: 36753299
DOI: 10.1556/2060.2022.00122