Pediatric Annular Pancreas: A 12-Year Experience

Authors

  • Rangsan Niramis Department of Surgery, Children's Hospital, Rajavithi Road, Bangkok 10400 Thailand.
  • Sukawat Watanatittan Department of Surgery, Children's Hospital, Rajavithi Road, Bangkok 10400 Thailand.
  • Maitree Anuntkosol Anuntkosol Department of Surgery, Children's Hospital, Rajavithi Road, Bangkok 10400 Thailand
  • Tongkao Rattanasuwan Department of Surgery, Children's Hospital, Rajavithi Road, Bangkok 10400 Thailand.
  • Veera Buranakitjaroen Department of Surgery, Children's Hospital, Rajavithi Road, Bangkok 10400 Thailand.

Abstract

                Annular pancreas is a rare congenital anomaly that consists of normal pancreatic tissue arranging in a continuous ring around the descending duodenum. This paper reported an experience of 52 pediatric patients with annular pancreas and duodenal obstruction who were treated at the Surgical Department of the Children's Hospital during 1 985- 1996. Thirty-five were male and seventeen were female. Age at onset of symptom ranged from I day to 20 months. Vomiting was the most common presentation in these patients. Jaundice and maternal polyhydramnios were noted in 50 and 21 per cent respectively. All underwent surgical treatment and duodenoduodenostomy was the most common procedure performed. Complete duodenal obstruction with annular pancreas was noted in 35 of 52 cases and their survival rate was 74.3 per cent. Incomplete duodenal obstruction with annular pancreas was found in 17 of 52 patients and the survival rate was 88.2 per cent. The overall survival rate was 78.9 per cent. Congenital heart disease, pulmonary complication, prematurity and septicemia were among the major causes of death.

                Our experience from this study suggested that the high incidence of associated serious congenital anomalies resulted in the high mortality in these patients. Duodenal bypass by duodenoduodenostomy was the most popular and effective procedure for correction of duodenal obstruction with annular pancreas.

References

1. Kierman PD, ReMine SG, Kierman PC, et al. Annular pancreas: Mayo Clinic experience from 1957 to 1976 with review of the literature. Arch Surg 1980; 115:46-50.

2. Harberg FJ, Biggs TM Jr. Congenital duodenal obstruction. Am Surg 1963; 29:506-9.

3. Merrill Jr, Raffensperger PG. Pediatric annular pancreas: twenty years' experience. J Pediatr Surg 1976; 11:921-5.

4. Kiesewetter WB, Koop CE. Annular pancreas in infancy. Recent advances in surgery. Surgery 1954; 36:146-59.

5. Farringer JL Jr. Annular pancreas in infants and children. Surgery 1955; 37:638-43.

6. Hay DM, Greaney EM Jr, Hill JT, Annular pancreas as a cause of acute neonatal duodenal obstruction. Ann Surg 1961; 53:103-12.

7. Jackson JM. Annular pancreas and duodenal obstruction in the neonate. Arch Surg 1963; 87:379-83.

8. Kimura K, Tsugawa C, Ogawa k, et al. Diamond-shaped anastomosis for congenital duodenal obstruction. Arch Surg 1099; 112:1262-3.

9. Irving IM. Duodenal atresia and stenosis; annular pancreas. In: Lister J, Irving IM. 3rd eds. Neonatal Surgery, London: Butterworths, 1990:424-41.

10. Elliott GB, Kliman MR, Elliot KA. Pancreatic annulus: a sign or a cause of duodenal obstruction. Can J Surg 1968; 11:357-64.

11. Girvan DP, Stephens CA. Intrinsic duodenal obstruction: a twenty-five year review of its surgical management and consequence. J Pediatr Surg 1974: 9:833-9.

12. Ladd WE. Congenital duodenal obstruction. Surgery 1937; 1:878-85.

13. Young DG, Wilkinson AW. Abnormalities associated with neonatal duodenal obstruction. Surgery 1968;63:832-6.

14. Wayne ER, Burrington JD. Management of 97 children with duodenal obstruction. Arch Surg 1973; 107:857-60.

15. Harberg JF, Pokorny WJ, Hahn H. Congenital duodenal obstruction: a review of 65 cases. Am J Surg 1978; 138:825-8.

16. Rickham PP. Annular pancreas in the newborn. Arch Dis Child 1954: 29ะ80-3.

17. Al-Salem AH, Khawaja S, Grent C, et al. Congenital intrinsic duodenal obstruction: problems in the diagnosis and management. J Pediatr Surg 1989: 24:1247-9.

18. Bailey PV, Tracy TF Jr, Conners RH, et al. Congenital duodenal obstruction: a 32-year review. J Pediatr Surg 1993; 28:92-5.

19. Lloyd-Jones W, Mountain JC, Warren Kw. Annular pancreas in the adult. Ann Surg 1972; 176:163-7.

20. Yasui A, Nimura Y, Kondon S, et al. Duodenal obstruction due to annular pancreas associated with pancreatic head carcinoma. Hepatogastroenterology 1995;42:1017-22.

21. Urayama S, Kozarek R, Ball T, et al, Presentation and treatment of annular pancreas in an adult population, Am J Gastroenterol 1995;90:995-9.

22. Sevenet F, Vanthoumont I, Coche G, et al. Acute pancreatitis disclosing an uncommon form of annular pancreas, Gastroenterol Clin Biol 1996:20:494-6.

23. Mast WH, Telle Ld, Turek RO. Annular pancreas: errors in diagnosis and treatment of eight cases. Am J Surg 1957;94:80-9.

24. OrrLA, Powell RW, Melhem RE. Sonographic demonstration of annular pancreas in the newborn. J Ultrasound Med 1992: 11:373-5.

25. Norton KI, Tenreiro R, Rabinowitz JG. Sonographic demonstration of annular pancreas and a distal duodenal diaphragm in a newborn. Pediatr Radiol 1992; 22:66-7.

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Published

1998-09-30

How to Cite

1.
Niramis R, Watanatittan S, Anuntkosol MA, Rattanasuwan T, Buranakitjaroen V. Pediatric Annular Pancreas: A 12-Year Experience. Thai J Surg [Internet]. 1998 Sep. 30 [cited 2024 Dec. 24];19(3):85-90. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/250030

Issue

Vol. 19 No. 3 (1998): July - September

Section

Original Articles

License

Articles must be contributed solely to The Thai Journal of Surgery and when published become the property of the Royal College of Surgeons of Thailand. The Royal College of Surgeons of Thailand reserves copyright on all published materials and such materials may not be reproduced in any form without the written permission.