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Annular pancreas

An annular pancreas is a ring of pancreatic tissue that encircles the duodenum (the first part of the small intestine). The normal position of the pancreas is next to, but not surrounding the duodenum.

Causes

Annular pancreas is problem present at birth (congenital defect). 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 syndrome
  • Excess amniotic fluid during pregnancy (polyhydramnios)
  • Other congenital gastrointestinal problems
  • Pancreatitis

Symptoms

Newborns may not feed well. They may spit up more than normal, not drink enough breast milk or formula, and cry.

Adult symptoms may include:

Treatment

Treatment most often involves surgery to bypass the blocked part of the duodenum.

Outlook (Prognosis)

The outcome is most often good with surgery. Adults with an annular pancreas are at increased risk for pancreatic or biliary tract cancer.

Possible Complications

Complications may include:

  • Obstructive jaundice
  • Pancreatic cancer
  • Pancreatitis (inflammation of the pancreas)
  • Peptic ulcer
  • Perforation (tearing a hole) of the intestine due to obstruction
  • Peritonitis

When to Contact a Medical Professional

Call your health care provider if you or your child has any symptoms of annular pancreas.

References

Bales C, Liacouras CA. Intestinal atresia, stenosis, and malrotation. In: Kliegman RM, Stanton BF, St Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 330.

Semrin MG, Russo MA. Anatomy, histology, embryology, and developmental anomalies of the stomach and duodenum. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 48.

Update Date 10/27/2015

Updated by: Subodh K. Lal, MD, gastroenterologist with Gastrointestinal Specialists of Georgia, Austell, GA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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