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Gastrointestinal system
Published in Aida Lai, Essential Concepts in Anatomy and Pathology for Undergraduate Revision, 2018
Annular pancreas Pancreas completely encircles duodenum, resulting in obstructionManagement: duodenoduodenostomy bypass
Liver, biliary system and pancreas
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Satyajit Bhattacharya, Adrian O’Sullivan
Annular pancreas may present with vomiting, with or without bile. Fifty percent of cases present in the newborn, where urgent operation is needed. The other 50% present between the ages of 20 to 70, when inflammation of the pancreas leads to constrictive symptoms.
The accessory organs: Pancreas, liver and gallbladder
Published in Paul Ong, Rachel Skittrall, Gastrointestinal Nursing, 2017
Annular pancreas is a rare congenital malformation that occurs due to incomplete rotation of the pancreatic ventral bud during embryogenesis. The ventral and dorsal parts fuse through a circumferential branch. This abnormal ring of pancreatic tissue encircles the second part of the duodenum (Figure 6.5). The anomaly is believed to be the result of incomplete migration of the ventral pancreatic bud during embryogenesis. Other congenital anomalies associated with annular pancreas are intestinal rotation, trisomy 21 (Down syndrome), cardiac defects, tracheoesophageal fistulae, duodenal atresia and pancreas divisum.
Neonate with Congenital Duodenal Obstruction and Ectopic Hepatic Parenchyma
Published in Fetal and Pediatric Pathology, 2022
Shishir Kumar, Parveen Kumar, Khushboo Jha, Arti Khatri
A 2-day-old male neonate presented with abdominal distension and gastric vomiting after every feed. X-ray abdomen showed classical double bubble appearance suggestive of duodenal obstruction. Vitals were stable with hematological investigations within normal limits for age, including liver and renal function tests. The baby underwent exploratory laparotomy, which revealed an annular pancreas. Classical Kimura’s duodeno-duodenostomy was performed. Intraoperative, a cystic structure was seen hanging from the stomach's greater curvature by a thin pedicle (Fig. 1). The cyst was excised along with its pedicle. There was no communication with the gastric lumen nor any attachment with surrounding structures. The cut section had straw-colored fluid. The microscopic examination revealed a cyst with flattened cell lining with hepatic tissue in its wall showing presence of bile ducts and immunopositivity for Hepar-1 (Fig. 2A–D). The cyst's lining cells were diffusely immunopositivity for calretinin (Fig. 2E), WT-1, D2-40 and focally for CK, confirming its mesothelial origin. The lining cells were immuno-negative for CD34. No definite portal vein or hepatic artery were identified. There were no inflammatory infiltrates, nuclear atypia, nuclear pleomorphism, or pseudo-acinar arrangement on microscopic examination. As there was no connection with native liver tissue, a diagnosis of a mesothelial cyst with ectopic hepatic parenchyma was made.
Clinical outcome of pregnancies with the prenatal double bubble sign – a five-year experience from one single centre in mainland China
Published in Journal of Obstetrics and Gynaecology, 2018
A double bubble detected on antenatal ultrasound is a serious finding that usually implies an obstruction proximal Treitz’s ligament. However, there are other anomalies that mimic a double bubble sign, so aetiologies in addition to duodenal obstruction should always be considered. It can be associated with proximal jejunal atresia or oesophageal atresia, a jejunal duplication cyst, duodenal duplication or even non- bowel anomaly, as demonstrated in this study and other reports (Malone et al. 1997; Schwartzberg and Burjonrappa 2013; Kucińska-Chahwan et al. 2015). Careful sonographic examination can sometimes result in the identification of the anatomic cause of double bubble. For example, annular pancreas can be diagnosed by visualising a hyperechogenic band around the duodenum (Dankovcik et al. 2008). In proximal jejunal atresia, three instead of two bubbles are present (Tongsong and Chanprapaph 2000). Duodenal duplication is suspected with detection of double bubble together with the following triad: (1) lack of polyhydramnios, (2) failure to demonstrate the double bubble sign consistently on a transverse abdominal image and (3) presence of normal, or dilated, distal bowel pattern (Malone et al. 1997).
In with acute bronchitis; out with duodenal perforation: the potentially harmful cascade of over-testing. A case report
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Karamjit Dhaliwal, Victoria Malkhasyan, Mohammed Elhassan
During this admission, surgical consultation was requested for the pancreatic ‘mass’ and they recommended gastroenterology consultation to pursue another EUS-FNA to rule out the possibility of malignancy again. She underwent repeat EUS-FNA of the pancreatic ‘mass’ as well as FNA of the thyroid mass. Unfortunately, the EUS-FNA this time was complicated by duodenal perforation and she required an emergent exploratory laparotomy. During surgery, it was noted that she actually had an annular pancreas. In the pathology report, no malignant cells were noted from the pancreatic ‘mass’ biopsy, and the thyroid biopsy showed a benign thyroid nodule with cystic degeneration. Overall, she was hospitalized for 9 days and slowly recovered from her procedural complications and was discharged home.