A Rare Cause of Sub-Acute Proximal Intestinal Obstruction Due to Annular Pancreas

Abstract

Background: Annular pancreas is a rare congenital anomaly due to an abnormal fusion between the tip of the ventral pancreatic bud and the duodenum at about the 7th gestational week and, presenting usually with symptoms due to duodenal obstruction. We report a case of a 2- year old girl who presented electively for investigations of symptoms of a sub-acute proximal intestinal obstruction. Investigations revealed a partial duodenal obstruction and an exploratory laparatomy surprisingly showed a partially obstructing annular pancreas for which she underwent a bypass procedure. A precise preoperative diagnosis of annular pancreas can be difficult without good imaging and the diagnosis and surgical management decision may only be made at laparatomy. Children with atypical or mild symptoms of intestinal obstruction associated with failure to thrive should be investigated fully for a probable mechanical cause.
Keywords: Annular pancreas, Duodenal obstruction, Surgical bypass