Adult with epigastric pain, vomitting, and early satiety with PMH of PUD and pancreatitis

Annular Pancreas

• 50% discovered in childhood
• Associated  with other congenital anomalies: EA, TEF, DA/DS/DD, inperforated anus, malrotation, Down’s
• 85% 2nd portion of duodenum
• Usually incidental finding but may cause duodenal obstruction and “double bubble” sign, N/V, abdominal pain*
• TX: gastrojejunostomy, duodenojejunostomy
• CX: periampullary PUD, pancreatitis

Duke DDX Duodenal Narrowing/Obstrucion

• Congenital – duodenal artesia in neonates, annular pancreas, duodenal web/diaphragm, Ladd’s bands, duplication cyst
• Inflammatory – postbulbar ulcer, Crohn, Infective(TB, Strongyloides), pancreatitis, XRT
• Malignant – duodenal carcinoma, lymphoma, pancreatic carcinoma, mets
• Trauma, intramural hematoma
• SMA syndrome
• Aortic anuerysm