DefinitionAn 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, incidence, and risk factorsAnnular 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 syndromeExcess amniotic fluid during pregnancy (polyhydramnios)Other congenital gastrointestinal problemsPancreatitis
SymptomsNewborns 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 eatingNausea or vomiting
Signs and testsTests include:Abdominal ultrasoundAbdominal x-rayCT scanUpper GI and small bowel series
TreatmentSurgical bypass of the blocked part of the duodenum is the usual treatment for this disorder.
Expectations (prognosis)The outcome is usually good with surgery. Adults with an annular pancreas are at increased risk for pancreatic or biliary tract cancer.
ComplicationsObstructive jaundicePancreatic cancerPancreatitis (inflammation of the pancreas)Peptic ulcerPerforation (tearing a hole) of the intestine due to obstructionPeritonitis
Calling your health care providerCall for an appointment with your health care provider if you or your child has any symptoms of annular pancreas.
ReferencesSemrin 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.