Cunha José Eduardo M, de Lima Marcelo Simas, Jukemura José, Penteado Sonia, Jureidini Ricardo, Patzina Rosely A, Siqueira Sheila Aparecida C
Department of Gastroenterology, Surgical Division, São Paulo University Medical School, São Paulo, Brazil.
Pancreatology. 2005;5(1):81-5. doi: 10.1159/000084493. Epub 2005 Mar 16.
Annular pancreas (AP) is a rare congenital anomaly, usually present in childhood, with symptoms due to duodenal obstruction; however, this condition can manifest in adulthood with abdominal pain, pancreatitis and pancreatic head mass. The authors present a case of AP observed in a 22-year-old patient that presented an unusual dual-phase clinical manifestation of duodenal obstruction in infancy that was treated by a duodenojejunostomy, and abdominal pain due to chronic pancreatitis in the adult age. MRI with cholangiopancreatography played a decisive role in achieving the correct diagnosis. The patient was treated by a pylorus-preserving Whipple procedure, with resection of the previous duodenojejunostomy. Pancreatic changes characteristic of chronic pancreatitis were demonstrated both in the AP and in the resected pancreatic segment. A marked biliopancreatic ductal anomaly not previously described in the literature was demonstrated by radiologic examination of the surgical specimen. The pathogenesis of AP, the importance of its association with benign and malignant pancreatic disease and the treatment alternatives are discussed by the authors.
环状胰腺（AP）是一种罕见的先天性异常，通常在儿童期出现，因十二指肠梗阻而出现症状；然而，这种情况在成年期可表现为腹痛、胰腺炎和胰头肿块。作者报告了一例22岁患者的环状胰腺病例，该患者在婴儿期出现了不寻常的双期临床表现，即十二指肠梗阻，接受了十二指肠空肠吻合术治疗，成年后因慢性胰腺炎出现腹痛。磁共振胰胆管造影（MRI）在做出正确诊断方面起了决定性作用。患者接受了保留幽门的胰十二指肠切除术，并切除了先前的十二指肠空肠吻合术。在环状胰腺和切除的胰腺节段中均显示出慢性胰腺炎的典型胰腺改变。通过对手术标本的影像学检查发现了一种文献中未曾描述过的明显的胆胰管异常。作者讨论了环状胰腺的发病机制、其与胰腺良恶性疾病关联的重要性以及治疗选择。
