Alshiekh Ali, Alkurdi M Fadi, Hadakie Rana, Alarsan Mohammed, Sukkar Luna, Hamed Hamoud
Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic; Department of Surgery, Al-Assad University Hospital, Damascus University, Damascus, Syrian Arab Republic.
Department of Surgery, Faculty of Medicine, Damascus University, Damascus, Syrian Arab Republic; Department of Surgery, Al-Assad University Hospital, Damascus University, Damascus, Syrian Arab Republic.
Int J Surg Case Rep. 2024 Sep;122:110077. doi: 10.1016/j.ijscr.2024.110077. Epub 2024 Jul 23.
Annular pancreas (AP) is a rare condition that usually is not associated with symptoms in adults. However, in some patients, AP may cause non-specific symptoms such as abdominal pain and vomiting, making its diagnosis challenging. The current case report presents a challenging diagnosis of an AP case and surgical management of it by performing duodenoduodenostomy.
A 47-year-old female presented with chronic abdominal pain and vomiting after meals. The examination using CT showed a complete ring of pancreatic tissue encircling the descending part of the duodenum, confirming the diagnosis of AP. Therefore, the patient underwent duodenoduodenostomy, in which the obstruction was bypassed.
AP is a rare condition characterized by a band of pancreatic tissue that encircles the second part of the duodenum. Most cases of AP in adults remain asymptomatic. However, when AP is symptomatic, it is associated with vague abdominal symptoms. The primary management of symptomatic AP in adults involves surgical bypass of the annulus through performing gastrojejunostomy or duodenojejunostomy. While duodenoduodenostomy is less favorable, we opted for it due to the limitation of the obstruction to a specific segment of the duodenum.
This case underscores the importance of considering AP as a potential cause in the differential diagnosis of vague and persistent gastrointestinal symptoms. Moreover, most studies concerning the management of AP have consisted of case reports or small case series. This emphasizes the need for further studies to enhance our understanding of the most appropriate approach for managing each case of AP.
环状胰腺（AP）是一种罕见疾病，在成人中通常不伴有症状。然而，在一些患者中，AP可能会引起腹痛和呕吐等非特异性症状，这使得其诊断具有挑战性。本病例报告展示了一例具有挑战性的AP病例诊断以及通过十二指肠十二指肠吻合术进行的手术治疗。
一名47岁女性出现餐后慢性腹痛和呕吐症状。CT检查显示胰腺组织完整环绕十二指肠降部，确诊为AP。因此，该患者接受了十二指肠十二指肠吻合术，绕过了梗阻部位。
AP是一种罕见疾病，其特征是胰腺组织带环绕十二指肠第二部。大多数成人AP病例无症状。然而，当AP出现症状时，会伴有模糊的腹部症状。成人有症状AP的主要治疗方法是通过胃空肠吻合术或十二指肠空肠吻合术对环状物进行手术旁路。虽然十二指肠十二指肠吻合术不太常用，但由于梗阻局限于十二指肠的特定节段，我们选择了该术式。
本病例强调了在鉴别诊断模糊且持续的胃肠道症状时将AP视为潜在病因的重要性。此外，大多数关于AP治疗的研究都由病例报告或小病例系列组成。这强调了需要进一步研究以加深我们对处理每例AP最合适方法的理解。
