pediatrics
Duodenal Obstruction
Annular pancreas
Annular pancreas is a rare congenital anomaly (5 to 15 per 100,000 live births [ References ]), often associated with About two thirds of affected people remain asymptomatic. Of those who develop symptoms, most present in the neonatal period, but manifestation may be delayed until adulthood. Neonates present with feeding problems and emesis that may be bilious. The diagnosis of annular pancreas can be suggested by an x-ray of the abdomen showing the same double-bubble sign seen in Duodenal atresia . The diagnosis can also be made by an upper GI series and is more definitively made with CT or magnetic resonance cholangiopancreatography. ERCP can be done in older children. Treatment of annular pancreas is surgical bypass of the annular pancreas with duodenoduodenostomy, duodenojejunostomy, or gastrojejunostomy. Resection of the pancreas should be avoided because of the potential complications of pancreatitis and pancreatic fistula development. 