Annular Pancreas in Children: A Decade of Experience

Abstract

Objective: Annular pancreas is an uncommon cause of duodenal obstruction in children. In this study, the clinical, radiological, and prognostic fi ndings related to this disorder over a 12-year review period were analyzed. Materials and Methods:A retrospective review of 22 patients with annular pancreas who were treated with surgical repair between April 1998 and February 2010 was performed at two diff erent pediatric surgical units. Presenting symptoms, associated anomalies, radiological fi ndings, the type of surgery performed, postoperative outcomes, and complications were analyzed.Results: Twenty-two patients were identifi ed. Thirteen of the 22 patients (59.1%) were born prematurely, 11 patients (50%) had low birth weight, 2 patients (9.1%) had very low birth weight and 1 patient (4.5%) had extremely low birth weight. The mean birth weight was 2285.23±675.12 g. (970-3300). All patients presented with vomiting, which was bilious in nine (40.9%). Nine patients (40.9%) had chromosomal anomalies. Corrective surgery consisted of duodenoduodenostomy in 9 patients (40.9 %), duodenojejunostomy in 9 patients (40.9%), and gastrojejunostomy in 4 patients (18.1%). Fourteen of the 22 patients have survived (63.6%). The causes of death were combinations of sepsis, pneumonia, brain hemorrhage, and cardiac anomaly. Conclusion:Infants with annular pancreas associated with duodenal obstruction were often born prematurely and/or had low birth weights; many had cardiovascular anomalies. Annular pancreas associated with duodenal obstruction correlated strongly with the trisomy 21 karyotype among the chromosomal anomalies, as did duodenal atresia. The oral feeding tolerance time was nearly the same for all patients regardless of the surgical procedure used.

Colonic atresia associated with annular pancreas: An extremely rare and previously unreported association

“…[ 4 ] Although there is a fibrous constricting ring around the second part of the duodenum, the duodenal obstruction is usually due to an associated atresia or stenosis at the same level. [ 5 ] So the onset of symptoms of isolated annular pancreas may be delayed. There is early onset of vomiting with minimal or no abdominal distension.…”

The main radiologic findings in annular pancreas

“…It can be categorized as complete or partial and as intrinsic or extrinsic. Extrinsic duodenal obstruction has many causes, including annular pancreas, malrotation, and anterior portal vein ( 5 ) .…”

“…An annular pancreas is due to failure of the ventral bud to rotate, resulting in incarceration of the duodenum ( 7 ) . In general, an annular pancreas is symptomatic in children, especially in the neonatal period ( 5 ) , the main symptoms being bilious vomiting and abdominal distention ( 6 ) . In adults, it is typically asymptomatic and is diagnosed as an incidental finding ( 5 , 8 ) .…”

Surgical management of newborns with combined tracheoesophageal fistula, esophageal atresia, and duodenal obstruction

“…Duodenal obstruction has an incidence of 1/7000 live births and can be caused by duodenal atresia (DA) or annular pancreas (AP) [3] . AP is an uncommon congenital anomaly, and duodenal obstruction most commonly presents in the infancy or early childhood of patients [4] . The incidence of DA combined with EA varies between 3% and 6%, [5] and DA combined with EA is often associated with significant morbidity and mortality [6] .…”

“… [3] AP is an uncommon congenital anomaly, and duodenal obstruction most commonly presents in the infancy or early childhood of patients. [4] The incidence of DA combined with EA varies between 3% and 6%, [5] and DA combined with EA is often associated with significant morbidity and mortality. [6] Combined presence of EA/TEF and duodenal obstruction always lead to several management challenges, such as determination of the treatment order and the treatment pattern (together or staged).…”