PRESENTATION AND TREATMENT OF ANNULAR PANCREAS IN AN ADULT-POPULATION

Objective: To describe a series of adult patients with annular pancrea s, their presentation, and treatment modalities. Method: A retrospecti ve chart review of patients seen at a multispecialty referral center f rom 1977 to 1994. Results: Seven adult patients (ages ranging from 33 to 77 yr, four females and three males) presented with various symptom s and signs: abdominal pain (six patients) gastric outlet obstruction (two), pancreatitis (two), pancreatic mass (two), gastric/duodenal ulc er (one), and/or postoperative obstructive jaundice (one). The duratio n of symptoms ranged from 1 wk to 16 yr before diagnosis (median 18 mo nths). Upper GI radiography was consistent with annular pancreas in tw o cases, CT scan in two cases (neither of which actually depicted the annulus), and four of six successful endoscopic retrograde cholangiopa ncreatographies. Three patients were diagnosed during operative proced ures. Five of the seven patients required therapeutic operative proced ures that included transduodenal sphincteroplasty, duodenojejunostomy, gastrojejunostomy, subtotal gastrectomy, or Whipple procedure. Four o f the five had significant symptomatic relief. In one case, endoscopic sphincterotomy and biliary stent placement was therapeutic. Conclusio ns: 1) Annular pancreas occasionally presents in the adult population. 2) Although gastric outlet obstruction was seen in two of seven patie nts, a plethora of additional presentations included pancreatic mass, pancreatitis, peptic ulcer disease, and post-operative obstructive jau ndice. 3) Diagnosis of annular pancreas was most commonly suggested by upper GI series or endoscopic retrograde cholangiopancreatography. Ho wever, fully 40% of diagnoses required surgery for confirmation. 4) In contrast to the pediatric population in whom gastrojejunostomy or duo denojejunostomy is the treatment of choice, a variety of surgical as w ell as interventional endoscopic procedures were utilized for effectiv e treatment in adults with annular pancreas.