yemenjmedYemen Journal of MedicinecoVolume 3 Issue 2MultidisciplinaryEnglishMay-August 2024NNY20240911ArticleAnnular pancreas: A rare cause of duodenal obstruction in elderlyEnglishY160162George SarinZacharia1EnglishNAnu Jacob1EnglishY10.18231/j.yjom.2024.014Pancreas annulare is a rare congenital anomaly in which a band of pancreatic tissue partially or completely encloses the second part of the duodenum. The anomaly may be asymptomatic throughout life; when symptomatic, it may manifest as pancreatitis, peptic ulcer, duodenal obstruction, or rarely, extrahepatic biliary obstruction. We report a patient aged 74 years who presented with signs of gastric outlet obstruction. The diagnosis was confirmed preoperatively by computed tomography as duodenal stenosis due to a annular pancreas and was successfully treated with surgical duodenojejunostomy. Only a few similar cases have been described in the published medical literature. This case highlights the need to think beyond the common causes of gastric outlet or duodenal obstruction. In addition, cross-sectional abdominal imaging has become an inevitable tool in diagnosing and treating abdominal pathologies, allowing accurate diagnosis and planned surgical interventions.EnglishAnnular pancreas, Duodenal obstruction, Vomiting, Gastric Outlet Obstructionhttps://www.yemenjmed.com/admin/abstract?id=119References16191. Zyromski NJ, Sandoval JA, Pitt HA. Annular pancreas: dramatic differences between children and adults. J Am Coll Surg. 2008;206(5):1019and;ndash;25.2. Alkhayyat M, Bachour S, Saleh A. The Epidemiology of Annular Pancreas in the United States: A Population-based Study. J Clin Gastroent. 2022;56(2):186and;ndash;91.3. Ravitch MM, Woods AC. Annular pancreas. Ann Surg. 1950;132:1116and;ndash;27.4. Shirkhoda A. Anomalies and anatomic variants of pancreas. In: and others, editor. Textbook of gastrointestinal radiology. Philadelphia: WB Saunders; 2000. p. 1754and;ndash;66.5. Nur NM, Artan A, Omar AA. Annular pancreas causing duodenal obstruction in a 23 year old women managed surgically for gastrojejunostomy; a case report. Int J Surg Case Rep. 2022;101:107804.6. Lee PC, Lebnethal E. Prenatal and postnatal development of the human exocrine pancreas. In: Go VL, Dimagno E, Gardner JD, editors. Pancreas: Pathology, pathobiology and disease . Raven Press; 1993. p. 57.7. Berrocal T, Torres I, Gutierrez J. Congenital anomalies of the upper gastrointestinal tract. Radiographics. 1999;19:855and;ndash;72.8. Chen YC, Yeh CN, Tseng JH. Symptomatic adult annular pancreas. J Clin Gastroenterol. 2003;36:446and;ndash;50.9. England RE, Newcomer MK, Leung JW. Case report: annular pancreas divisum-a report of two cases and review of the literature. Br J Radiol. 1995;68:324and;ndash;8.10. Urayama S, Kozarek R, Ball T. Presentation and treatment of annular pancreas in an adult population. Am J Gastroenterol. 1995;90(6):995and;ndash; 9.11. Dharmsathaphorn K, Burrel M, Dobbins J. Diagnosis of annular pancreas with endoscopic retrograde cholangiopancreatography. Gastroenterology. 1979;77(5):1109and;ndash;23.12. Johnston DW. Annular pancreas: a new classification and clinical observations. Can J Surg. 1978;21(3):241and;ndash;5.13. Alahmadi R, Almuhammadi S. Annular pancreas: a cause of gastric outlet obstruction in a 20-year-old patient. Am J Case Rep. 2014;15:437and;ndash;77.14. Sandrasegaren K, Patel A, Fogel EL. Annular pancreas in adults. Am J Roentgenol. 2009;193(2):455and;ndash;60.15. Yogi Y, Shibue T, Hashimoto S. Annular pancreas detected in adults, diagnosed by endoscopic retrograde cholangiopancreatography: report of four cases. Gastroenterol. 1987;22(1):92and;ndash;9.16. Thomford NR, Knight PR, Pace WG. Annular pancreas in the adult: selection of operation. Ann Surg. 1972;176(2):159and;ndash;62.17. De Ugarte D, Dutson EP, Hiyama DT. Annular pancreas in the adult: management with laparoscopic gastrojejunostomy. Am Surg. 2006;72:71.