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Journal of Applied Clinical Medical... Jan 2022To investigate annular pancreas in adults using imaging features displayed on computed tomography (CT) and magnetic resonance imaging (MRI).
BACKGROUND AND PURPOSE
To investigate annular pancreas in adults using imaging features displayed on computed tomography (CT) and magnetic resonance imaging (MRI).
METHODS
Retrospective review of annular pancreas in patients undergoing CT or MRI examinations. Two abdominal radiologists blindly reviewed the CT, MRI, and magnetic resonance cholangiopancreatography (MRCP) images from the Picture Archiving and Communication Systems (PACS). A Kruskal-Wallis test was performed to evaluate subjective scoring, with Mann-Whitney test for the comparison. A p-value less than 0.05 was considered statistically significant.
RESULTS
Eleven patients (45.8%) presented a complete ring of pancreatic tissue surrounding duodenum, displayed as circular, triangular, or sandwich sign configuration, the other 13 patients (54.2%) had incomplete annular pancreas which displayed a crocodile jaw appearance, pancreatic tissue extending in a posterolateral or anterolateral direction towards duodenum. When comparing CT images of each sequence, the arterial phase group had the highest score compared with the venous phase and the plain film group (χ = 58.21, p < 0.05). When comparing MRI enhancement volumetric interpolated breath-hold examination (VIBE) sequences, arterial phase group scores were the highest (χ = 18.98, p < 0.05).
CONCLUSIONS
Both CT and MRI could detect annular pancreas, with artery phase being the best sequence to diagnose annular pancreas.
Topics: Adult; Humans; Magnetic Resonance Imaging; Pancreas; Pancreatic Diseases; Retrospective Studies; Tomography, Spiral Computed; Tomography, X-Ray Computed
PubMed: 34845829
DOI: 10.1002/acm2.13487 -
Asian Journal of Surgery Jan 2022
Topics: Foot; Hand; Humans; Pancreas; Pancreatic Diseases
PubMed: 34823993
DOI: 10.1016/j.asjsur.2021.11.035 -
Journal of Indian Association of... 2021
PubMed: 34728929
DOI: 10.4103/jiaps.JIAPS_7_21 -
Insights Into Imaging Jul 2021Abdominal computed tomography (CT) is frequently performed to evaluate gastrointestinal pathologic conditions. The majority of the gastrointestinal radiology literature... (Review)
Review
Abdominal computed tomography (CT) is frequently performed to evaluate gastrointestinal pathologic conditions. The majority of the gastrointestinal radiology literature has concentrated on the colon, stomach, and distal small bowel. The duodenum is often overlooked on imaging, namely on CT, but its anatomy (intra and retroperitoneal) and location in such close proximity to other viscera results in involvement by a multitude of primary and secondary processes, some of them exclusive to this bowel segment. While some conditions, like duplications, lipomas, and diverticula, are usually asymptomatic and are incidentalomas that have no pathologic significance, others are symptomatic and very relevant and should be recognized by every general radiologist: development conditions such as annular pancreas and gut malrotation; inflammatory processes such as ulcers and secondary involvement from pancreatitis; neoplastic conditions such as adenocarcinoma, lymphoma, or local extension from adjacent malignancies. They all can be reliably diagnosed with CT. In this article, we demonstrate the typical imaging features of various diseases involving the duodenum, such as developmental, traumatic, inflammatory, infectious, neoplastic, and postsurgical pathologic conditions in alphabetical order, focusing mainly on upper gastrointestinal series (UGIS) and CT but also some radiography, ultrasound, and magnetic resonance (MR) imaging.
PubMed: 34232417
DOI: 10.1186/s13244-021-01045-y -
Frontiers in Genetics 2021The annular pancreas (AP) is a congenital anomaly of the pancreas that can cause acute abdominal pain and vomiting after birth. However, the genetic cause of AP is still...
The annular pancreas (AP) is a congenital anomaly of the pancreas that can cause acute abdominal pain and vomiting after birth. However, the genetic cause of AP is still unknown, and no study has reported AP in patients with 17q12 duplication. This study retrospectively analyzed the next-generation sequencing (NGS) data of individuals from January 2016 to June 2020 for 17q12 duplication. To identify the function of the key gene of in the 17q12 duplication region, human mRNA was microinjected into LiPan zebrafish transgenic embryos. A total of 19 cases of 17q12 duplication were confirmed. AP was diagnosed during exploratory laparotomy in four patients (21.1%). The other common features of 17q12 duplication included intellectual disability (50%), gross motor delay (50%), and seizures/epilepsy (31.58%). The ratio of the abnormal pancreas in zebrafish was significantly higher in the overexpression models. In conclusion, we first reported AP in patients with duplication of the 17q12 region, resulting in the phenotype of 17q12 duplication syndrome. Furthermore, our zebrafish studies verified the role of the gene in pancreatic development.
PubMed: 34025713
DOI: 10.3389/fgene.2021.615072 -
Journal of Surgical Case Reports Apr 2021Annular pancreas is defined by a ring of pancreatic tissue encircling the descending portion of the duodenum. It is exceptionally rare in adults and commonly diagnosed...
Annular pancreas is defined by a ring of pancreatic tissue encircling the descending portion of the duodenum. It is exceptionally rare in adults and commonly diagnosed during the investigation of symptoms arising due to its complications. Treatment usually involves the surgical correction with a duodenoduodenostomy, gastrojejunostomy or duodenojejunostomy. We discuss the case of a 66-year-old male patient who presented with symptoms of gastric outlet obstruction and was found to have an annular pancreas encircling the pylorus and the first and second portions of the duodenum and was treated by performing a gastrojejunostomy. Upper gastrointestinal series, computerized tomography (CT) scans, and magnetic resonance cholangeopancreatographys can all be used for preoperative diagnosis; however, endoscopic retrograde cholangiopancreatography (ERCP) is the diagnostic modality of choice. Nonetheless, many patients may only be diagnosed intraoperatively, especially those who cannot undergo an ERCP due to stenosis proximal to the duodenum or patients in whom the annulus may not be visible on CT scan.
PubMed: 33927863
DOI: 10.1093/jscr/rjab125 -
Folia Morphologica 2022A unique partial anomalous pulmonary venous return in combination with other rare malformations such as annular pancreas and a persistent umbilical vein was discovered...
A unique partial anomalous pulmonary venous return in combination with other rare malformations such as annular pancreas and a persistent umbilical vein was discovered in a female Caucasian cadaver during an anatomical dissection at the Paracelsus Medical University in Nuremberg, Germany. The pulmonary anomaly comprised the aberrant left superior pulmonary vein connecting the superior lobe of the left lung with the left brachiocephalic vein resulting in a left to right shunt. An annular pancreas without any signs causing duodenal compression was additionally found. To complete the constellation of malformations, a persistent umbilical vein within the round ligament fissure of the liver was also observed, connecting to an inferior branch of the extrahepatic left ramus of the portal vein. This rare constellation of malformations has been illustrated and thoroughly discussed with the currently available literature to develop a hypothesis for the genetic and developmental background.
Topics: Cadaver; Female; Humans; Pancreas; Pancreatic Diseases; Pulmonary Veins; Scimitar Syndrome
PubMed: 33749806
DOI: 10.5603/FM.a2021.0026 -
Journal of Gastrointestinal Surgery :... May 2021Portal annular pancreas (PAP) is an anatomic variation due to aberrant fusion of the ventral and dorsal pancreatic buds around the portal vein. In this article, we... (Review)
Review
INTRODUCTION
Portal annular pancreas (PAP) is an anatomic variation due to aberrant fusion of the ventral and dorsal pancreatic buds around the portal vein. In this article, we present a case report with a systematic review of literature of patients undergoing major pancreatic surgery with associated PAP. We also intend to discuss and suggest possible surgical strategies to minimise major postoperative complications.
METHODS
A systematic literature search was conducted using the terms "circumportal," "periportal," "pancreas," "annular pancreas," "portal annular pancreas" and "pancreas anomaly." All articles describing portal annular pancreas with surgical resection were included.
RESULTS
We identified a total of 53 patients of PAP from 29 articles, who underwent pancreatic resection with a median age of 65 years. POPF (postoperative pancreatic fistula) was demonstrated in 42.55% of patients and 34% had CR (clinically relevant)-POPF. Following pancreaticoduodenectomy, pancreatic stump was reconstructed in all patients with either pancreaticojejunostomy or pancreaticogastrostomy. Standard line of pancreatic transection, i.e., division of anteportal portion at the pancreatic neck and stapling of the retroportal process, resulted in 71% incidence of CR-POPF, whereas it was only 16% when extended resection was performed to achieve single pancreatic stump and 12.5% when retroportal portion was sutured or ligated. Amongst distal pancreatic resections, 66% had POPF and 33% developed CR-POPF.
CONCLUSION
It is of utmost importance for pancreatic surgeons to diligently look for and identify PAP in the preoperative imaging. Additional imaging in the form of MRCP helps to define abnormal pancreatic ductal anatomy. Surgeons need to be cognisant of pancreatic stump management in patients with PAP to reduce associated higher rates of POPF.
Topics: Aged; Humans; Pancreas; Pancreatic Diseases; Pancreatic Fistula; Pancreaticoduodenectomy; Pancreaticojejunostomy; Postoperative Complications
PubMed: 33555524
DOI: 10.1007/s11605-021-04927-0 -
Radiology Case Reports Apr 2021Annular pancreas is a rare congenital intestinal obstruction to be found in infants. It is characterized by nonbilious vomiting, abdominal distention, and feeding...
Annular pancreas is a rare congenital intestinal obstruction to be found in infants. It is characterized by nonbilious vomiting, abdominal distention, and feeding intolerance that share similar symptoms with other intestinal obstructions. We reported a case of 11-month-old female infant with a history of nonbilious vomiting after coughing as much as 6 times per day 1 day before admission. The patient had an incorrect provisional diagnosis of hypertrophic pyloric stenosis based on ultrasound. Later on, an upper gastrointestinal series showed dilatation of the second part of the duodenum which was successfully treated by a duodenostomy during laparotomy procedure. It is suggested that treating an intestinal obstruction needs a further investigation when the symptoms were continuously repeated.
PubMed: 33537107
DOI: 10.1016/j.radcr.2021.01.019 -
Surgical and Radiologic Anatomy : SRA May 2021Annular pancreas encountered in adults and jejunal arterial variations are rare. Anatomical variations can cause conflicts between oncology and surgical safety.
PURPOSE
Annular pancreas encountered in adults and jejunal arterial variations are rare. Anatomical variations can cause conflicts between oncology and surgical safety.
METHODS
Case report of a 68-year-old man suffering from vomiting because of an annular pancreas and a ductal adenocarcinoma of the pancreas head invading the second portion of the duodenum.
RESULTS
Contrast-enhanced computed tomography showed multiple arterial variations describing the absence of the coeliac trunk such that the left gastric artery (LGA), splenic artery and superior mesenteric artery (SMA) were arising separately from the aorta. The accessory left hepatic artery arose from the LGA; and both the common hepatic artery and combined trunk of the replaced right hepatic artery with the higher replaced first jejunal artery separately arose close to the root of the SMA. The patient underwent curative pancreaticoduodenectomy which achieved 3 years of recurrence-free survival.
CONCLUSION
This was an extraordinary case of annular pancreas with first jejunal arterial variation detailing an embryological interpretation as well as considerations for balancing short- and long-term outcomes.
Topics: Aged; Carcinoma, Pancreatic Ductal; Computed Tomography Angiography; Humans; Imaging, Three-Dimensional; Male; Mesenteric Artery, Superior; Pancreas; Pancreatic Diseases; Pancreatic Neoplasms; Pancreaticoduodenectomy; Treatment Outcome
PubMed: 33481131
DOI: 10.1007/s00276-020-02671-9