Annular pancreas in adults: imaging features in seven patients

Abstract

Annular pancreas is a rare congenital abnormality that may be associated with variable degrees of duodenal obstruction. This diagnosis is often overlooked in adult patients who present with symptoms suggestive of duodenal obstruction. Imaging evaluation aids in establishing the diagnosis. We evaluated the imaging findings in seven adult patients with known annular pancreas. Seven adult patients with abdominal symptoms had evaluation with one or more of the following imaging studies: upper gastrointestinal (UGI) series, computed tomography (CT), and endoscopic retrograde cholangiopancreatography (ERCP). All patients underwent subsequent laparotomy as a part of routine care. Surgical and imaging findings were correlated in each patient. UGI series is suitable for demonstrating different degrees of duodenal narrowing at the level of pancreatic annulus. Contrast-enhanced abdominal CT is useful in visualizing directly the complete or partial annular pancreatic tissue. ERCP is particularly useful in visualizing the annulus duct coursing around the duodenum. Imaging plays a pivotal role in the diagnosis of annular pancreas in adult patients avoiding surgery for confirmation with its associated cost and risks.