Annular pancreas causing duodenal obstruction in an adult

Description

A 35-year-old man was admitted following daily vomiting for 2 weeks. He reported bouts of unexplained vomiting over the preceding 10 years. Gastroscopy showed obstruction in the second part of the duodenum with normal mucosa on biopsy (figure 1). CT demonstrated dilation of the first part of the duodenum caused by narrowing of the second part (figure 2). There was no pancreatic mass. At laparotomy, a ring of pancreatic tissue was found encircling the second part of the duodenum causing obstruction (figure 3). This is a congenital abnormality known as annular pancreas. The annular pancreas was resected (figure 4). He was discharged 5 days after surgery and at subsequent outpatient review had no further vomiting. MRI 2 months after surgery showed an unobstructed duodenum (figure 5).

Figure 1

Gastroscopy image showing obstruction of the second...

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