The bile duct stenosis by a complete annular pancreas: A rare association

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The annular pancreas is a rare congenital anomaly with retained ventral pancreas encircling the duodenum. It can be either complete or incomplete. The annular pancreas may manifest clinically in the neonate, but in the elderly it can mimic a wide range of clinical entities as a duodenal obstruction, rarely as a biliary tract obstruction making the diagnosis difficult. At present imaging modalities such as CT, ERCP and MRCP are used to arrive at a diagnosis. We are reporting an unusual combination of annular pancreas and dilated biliary system due to distal common duct stenosis without pancreatitis or underlying malignancy which is a rare presentation in adults.