Summary about Disease
Annular pancreas is a rare congenital anomaly where the pancreas forms a ring around the duodenum (the first part of the small intestine). This ring can constrict the duodenum, causing obstruction. The severity of the obstruction can vary, leading to a range of symptoms from mild discomfort to complete blockage. It is typically diagnosed in infancy or early childhood, but milder cases can go unnoticed until adulthood.
Symptoms
Symptoms of annular pancreas depend on the degree of duodenal obstruction. Common symptoms include:
In Infants:
Vomiting (often bile-stained)
Abdominal distension
Feeding intolerance
Failure to thrive
In Adults:
Abdominal pain
Nausea
Vomiting
Feeling of fullness after eating small amounts
Possible pancreatitis
Causes
Annular pancreas is a congenital condition, meaning it is present at birth. The exact cause is unknown, but it is believed to be due to a developmental defect during pancreatic formation in the early stages of fetal development. Normally, the pancreas develops from two buds that rotate and fuse. In annular pancreas, one bud fails to rotate properly, resulting in a ring of pancreatic tissue encircling the duodenum.
Medicine Used
Annular pancreas is generally treated surgically, not with medication. While medications may be used to manage symptoms such as nausea or vomiting before surgery, there is no medicine that can correct the anatomical abnormality. Medications might be used for pain control post-operatively.
Is Communicable
Annular pancreas is not communicable. It is a congenital birth defect and cannot be spread from person to person.
Precautions
Since annular pancreas is a congenital condition, there are no precautions that can prevent its occurrence. Genetic counseling may be considered for families with a history of congenital anomalies, but this is not specific to annular pancreas. Following a healthy pregnancy is always recommended.
How long does an outbreak last?
Annular pancreas is not an infectious disease, so the term "outbreak" is not applicable. The condition is present from birth, and the duration of symptoms depends on the severity of the obstruction and when it is diagnosed and treated.
How is it diagnosed?
Diagnosis of annular pancreas typically involves imaging studies:
Prenatal Ultrasound: In some cases, it can be suspected prenatally if there is evidence of duodenal obstruction.
Abdominal X-ray: May show a "double bubble" sign, indicating duodenal obstruction.
Upper Gastrointestinal (GI) Series: Barium is swallowed, and X-rays are taken to visualize the esophagus, stomach, and duodenum. It can show narrowing of the duodenum.
CT Scan or MRI: These can provide more detailed images of the pancreas and duodenum, helping to confirm the diagnosis.
Endoscopy: Rarely used for diagnosis, but may be used to evaluate the duodenum.
Timeline of Symptoms
The timeline of symptoms varies:
Prenatal: May be suspected on prenatal ultrasound.
Infancy: Symptoms often present in the first few days or weeks of life.
Childhood/Adulthood: Milder cases may not be diagnosed until later in life when symptoms like intermittent abdominal pain or vomiting develop.
Important Considerations
Surgical Correction: The primary treatment for annular pancreas is surgical bypass of the obstructed duodenal segment. The ring of pancreatic tissue is usually not* removed, as this can damage the pancreatic duct and lead to pancreatitis or diabetes. A duodenojejunostomy or gastrojejunostomy is commonly performed.
Associated Anomalies: Annular pancreas can be associated with other congenital anomalies, such as Down syndrome, intestinal malrotation, and cardiac defects.
Long-term Follow-up: Patients who have undergone surgery for annular pancreas require long-term follow-up to monitor for complications such as strictures, adhesions, or pancreatitis.