RT Book, Section
A1 Conwell, Darwin L.
A1 Banks, Peter A.
A1 Greenberger, Norton J.
A2 Jameson, J. Larry
A2 Fauci, Anthony S.
A2 Kasper, Dennis L.
A2 Hauser, Stephen L.
A2 Longo, Dan L.
A2 Loscalzo, Joseph
SR Print(0)
ID 1177999794
T1 Other Conditions in Pancreatitis
T2 Harrison's Principles of Internal Medicine, 20e
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9781259644016
LK accesspharmacy.mhmedical.com/content.aspx?aid=1177999794
RD 2024/04/18
AB When  the  ventral  pancreatic  anlage  fails  to  migrate  correctly  to  make  contact  with  the  dorsal  anlage,  the  result  may  be  a  ring  of  pancreatic  tissue  encircling  the  duodenum.  Such  an  annular  pancreas  may  cause  intestinal  obstruction  in  the  neonate  or  the  adult.  Symptoms  of  postprandial  fullness,  epigastric  pain,  nausea,  and  vomiting  may  be  present  for  years  before  the  diagnosis  is  entertained.  The  radiographic  findings  are  symmetric  dilation  of  the  proximal  duodenum  with  bulging  of  the  recesses  on  either  side  of  the  annular  band,  effacement  but  not  destruction  of  the  duodenal  mucosa,  accentuation  of  the  findings  in  the  right  anterior  oblique  position,  and  lack  of  change  on  repeated  examinations.  The  differential  diagnosis  should  include  duodenal  webs,  tumors  of  the  pancreas  or  duodenum,  postbulbar  peptic  ulcer,  regional  enteritis,  and  adhesions.  Patients  with  annular  pancreas  have  an  increased  incidence  of  pancreatitis  and  peptic  ulcer.  Because  of  these  and  other  potential  complications,  the  treatment  is  surgical  even  if  the  condition  has  been  present  for  years.  Retrocolic  duodenojejeunostomy  is  the  procedure  of  choice,  although  some  surgeons  advocate  Billroth  II  gastrectomy,  gastroenterostomy,  and  vagotomy.