EC Clinical and Medical Case Reports

A 63-year-old female presented with chronic postprandial epigastric pain, nausea, and intermittent vomiting for several months, without jaundice or significant weight loss. Physical examination was unremarkable, and blood tests were within normal limits. A bili-MRI demonstrated pancreatic tissue encircling the second portion of the duodenum, confirming annular pancreas, a rare congenital anomaly caused by incomplete rotation of the ventral pancreatic bud during embryogenesis [1]. Axial T2-weighted images revealed a continuous ring of pancreatic parenchyma, causing duodenal compression. 3D MIP reconstruction highlighted a secondary pancreatic duct forming a loop before draining into the ampulla of Vater, a characteristic feature. Annular pancreas may remain asymptomatic or present with duodenal obstruction, peptic ulcers, or pancreatitis in adulthood [2,3]. MRI and CT are key for diagnosis, preventing delays and unnecessary procedures [4]. Recognizing annular pancreas is essential for timely management, as severe cases may require surgical bypass to relieve obstruction [5].

1. Zyromski NJ., et al. “Annular pancreas: Dramatic differences between children and adults”. Journal of the American College of Surgeons 5 (2008): 1019-1027.
2. Huddleston SV., et al. “Annular pancreas in an adult presenting with acute pancreatitis”. Radiology Case Reports 10 (2018): 11-16.
3. Jadvar H and Mindelzun RE. “Annular pancreas in adults: Imaging features in seven patients”. Abdominal Imaging 2 (1999): 174-177.
4. Gromski MA., et al. “Annular pancreas: Endoscopic and pancreatographic findings from a tertiary referral ERCP center”. Gastrointestinal Endoscopy 2 (2019): 322-328.
5. McGee AR., et al. “Annular pancreas”. Radiology 4 (1953): 532-535.