A RARE CASE OF A 27-YEAR-OLD FEMALE PRESENTED WITH DUODENAL OBSTRUCTION DUE TO ANNULAR PANCREAS

Abstract

Background. Annular pancreas is a rare congenital abnormality characterized by a ring of pancreatic tissue surrounding the descending portion of the duodenum. It is thought to originate from the incomplete rotation of the ventral pancreatic bud. Objective. To present a case description of a 27-year-old female with duodenal obstruction due to annular pancreas Material and methods. The clinical manifestations, laboratory and instrumental findings of a female patient. Results. We report the case of a 27-year-old female with 3 months history of upper abdominal pain, nausea, postprandial fullness, and recurrent vomiting. Physical examination revealed nothing except for the thin-built body. Routine biochemical and hematological investigations were within normal limits. The patient's standing direct abdominal graphy revealed air-fluid level and dilated both stomach and the first part of duodenum. Upper gastrointestinal series showed circumferential extrinsic compression on the 2nd portion of the duodenum. Abdominal computerized tomography (CT) and ultrasonography (USG) revealed a ring of pancreatic tissue encircling the second part of the duodenum. We present the clinical presentation, treatment plan which is performed through a duodenojejunostomy bypass procedure, and follow-up of the patient. Conclusions. Annular pancreas is associated with duodenal atresia. It usually appears in infancy but might become clinically evident in adulthood with obstruction of the duodenum. The symptoms include constipation, nausea, and vomiting. and usually arise due to obstruction to gastric emptying. In order to confirm the presence of annular pancreas, abdominal CT scans with high resolution and angiography protocols as well as magnetic resonance imaging are helpful.