Annular pancreas and current approaches to surgical management
DOI:
https://doi.org/10.18203/2349-2902.isj20250742Keywords:
Embryology, Annular pancreas, Pancreatitis, Bypass surgeryAbstract
Annular pancreas is an uncommon but well documented anatomical variant. Annular pancreas has a strong embryological basis, likely resulting from errors in rotation of the ventral duct of the embryological pancreas. Despite a low prevalence, annular pancreas is associated with surgical pathology that requires urgent intervention. In neonates and adults, duodenal obstruction can pose a life-threatening risk, and prolonged inflammation of related structures in adults can result in pancreatitis, cholangitis, and ultimately pancreaticobiliary malignancy. Currently, in cases of duodenal obstruction, bypass surgery has garnered favour over resection, whereas in cases of recurrent pancreatitis and cholangitis, endoscopic retrograde cholangiopancreatography (ERCP) is preferred. Further longitudinal investigation of the risk of developing foregut malignancy with bypass as opposed to resection would be beneficial in informing guidelines for surgical management.
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References
Last R. Part 7 Pancreas. Last's Anatomy Regional and Applied. 9th ed: Elsevier. 2020.
Mahadevan J. Anatomy of the pancreas and spleen. Surgery (Oxford). 2019;37(6):297-301. DOI: https://doi.org/10.1016/j.mpsur.2019.04.008
Tadokoro H, Takase M, Nobukawa B. Development and Congenital Anomalies of the Pancreas. Anatomy Res Int. 2011;1:7. DOI: https://doi.org/10.1155/2011/351217
Etienne D, John A, Menias C, Ward R, Tubbs R. Annular pancreas: A review of its molecular embryology, genetic basis and clinical considerations. Ann Ana. 2012;194(5):422-8. DOI: https://doi.org/10.1016/j.aanat.2012.04.006
Moore K, Persaud T. The digestive system. The developing human: clinically oriented embryology. 8th ed: WB Saunders. 2007.
Nagpal S, Peeraphatdit T, Sannapaneni S, Takahashi N, Kendrick M. Clinical spectrum of adult patients with annular pancreas: Findings from a large single institution cohort. Pancreatol. 2019;19(2):290-5. DOI: https://doi.org/10.1016/j.pan.2018.12.009
Zyromski N, Sandoval J, Pitt H, Ladd A, Fogel E. Annular Pancreas: Dramatic Differences Between Children and Adults. J Am College Surg. 2008;206(5):1019-25. DOI: https://doi.org/10.1016/j.jamcollsurg.2007.12.009
Ravitch M. Annular pancreas. Ann Surg. 1950;132(6):1116-27. DOI: https://doi.org/10.1097/00000658-195012000-00011
Baggott B, Long W. Annular pancreas as a cause of extrahepatic biliary obstruction. Am J Gastroenterol. 1991;86:224.
Sandrasegaran K, Patel A, Fogel E, Zyromski J. Annular Pancreas in Adults. Gastrointestinal Imaging. 2009;193(2):455-60.
Cai H, Wang X, Cai Y, Li Y, Meng L, Peng B. Laparoscopic Roux-en-Y duodenojejunostomy for annular pancreas in adults: case report and literature review. Annal Transl Med. 2018;6(11):56. DOI: https://doi.org/10.21037/atm.2018.05.13
Sessa F, Fiocca R, Tenti P, Solcia E, Tavani E. Pancreatic polypeptide rich tissue in the annular pancreas. Virchow's Arch Anatomy. 1983;399(2):227-332. DOI: https://doi.org/10.1007/BF00619582
Suda K. Immunohistochemical and Gross Dissection Studies of Annular Pancreas. Pathology International. 1990;40(7):505-8. DOI: https://doi.org/10.1111/j.1440-1827.1990.tb01592.x
Whelan T. Annular pancreas. Annals of Surgery. 1957;146(2):252-62. DOI: https://doi.org/10.1097/00000658-195708000-00015
Sandrasegaran K, Patel A, Fogel E, Zyromski N. Annular Pancreas in Adults. Am J Roentgenol. 2009;193(2):455-60. DOI: https://doi.org/10.2214/AJR.08.1596
Perumal S, Subramaniam S, Sathyanesan J, Palaniappan R. Annular pancreas in adults: a tertiary care institute experience and review of literature. Int Surg J. 2019;6(1):326-9.
Chittawadagi B, Senthilnathan P, Jankar S, Sabnis S, Palanivelu C. Laparoscopic Roux-en Y duodenojejunostomy: A safe and physiological treatment for symptomatic annular pancreas in adults. J Access Surg. 2020;16(2):1215. DOI: https://doi.org/10.4103/jmas.JMAS_245_18
Perumal S, Sugi R, Subramaniam V, Sathyanesan R, Palaniappan R. Annular pancreas in adults: a tertiary care institute experience and review of literature. Int J Surg. 2019;6(1):326-9. DOI: https://doi.org/10.18203/2349-2902.isj20185497
Liang Z, Lan M, Xu X, Liu F, Tao B. d-shaped versus side-to-side anastomotic duodenoduodenostomy in laparoscopic management of annular pancreas in children: a single-center retrospective comparative study. Translational Pediat. 2023;12(10):1791-9. DOI: https://doi.org/10.21037/tp-23-156
Maker V, Gerzenshtein J, Lerner T. Annular pancreas in the adult: two case reports and review of more than century of literature. Am J Surg. 2003;69:404-10. DOI: https://doi.org/10.1177/000313480306900509
Lim K, Lee A, Croagh D. Primary division of annular pancreas : a surgical technique. J Surg Case Reports. 2024;4(11):712. DOI: https://doi.org/10.1093/jscr/rjae712
Fogel E, Zyromski N, McHenry L, Watkins J, Pitt H. Annular Pancreas (AP) in the Adult: Experience At a Large Pancreatobiliary Endoscopy Center. Gastrointestinal Endoscopy. 2006;63(5):89. DOI: https://doi.org/10.1016/j.gie.2006.03.827
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