# Effective surgical management of gastric outlet obstruction symptoms caused by annular pancreas in an adult female: A case report

## TL;DR

A 47-year-old woman with chronic abdominal pain and vomiting was diagnosed with annular pancreas and successfully treated with a duodenoduodenostomy.

## Contribution

This case report highlights the effectiveness of duodenoduodenostomy in managing gastric outlet obstruction caused by annular pancreas in adults.

## Key findings

- Annular pancreas can cause non-specific gastrointestinal symptoms in adults.
- Duodenoduodenostomy is a viable surgical option for managing annular pancreas when the obstruction is localized.
- Diagnosis of annular pancreas is confirmed through CT or laparotomy.

## Abstract

Annular pancreas (AP) is a rare condition that usually is not associated with symptoms in adults. However, in some patients, AP may cause non-specific symptoms such as abdominal pain and vomiting, making its diagnosis challenging. The current case report presents a challenging diagnosis of an AP case and surgical management of it by performing duodenoduodenostomy.

A 47-year-old female presented with chronic abdominal pain and vomiting after meals. The examination using CT showed a complete ring of pancreatic tissue encircling the descending part of the duodenum, confirming the diagnosis of AP. Therefore, the patient underwent duodenoduodenostomy, in which the obstruction was bypassed.

AP is a rare condition characterized by a band of pancreatic tissue that encircles the second part of the duodenum. Most cases of AP in adults remain asymptomatic. However, when AP is symptomatic, it is associated with vague abdominal symptoms. The primary management of symptomatic AP in adults involves surgical bypass of the annulus through performing gastrojejunostomy or duodenojejunostomy. While duodenoduodenostomy is less favorable, we opted for it due to the limitation of the obstruction to a specific segment of the duodenum.

This case underscores the importance of considering AP as a potential cause in the differential diagnosis of vague and persistent gastrointestinal symptoms. Moreover, most studies concerning the management of AP have consisted of case reports or small case series. This emphasizes the need for further studies to enhance our understanding of the most appropriate approach for managing each case of AP.

•Annular pancreas (AP) is a rare congenital anomaly that is not usually associated with symptoms in adults.•In symptomatic cases, AP causes non-specific symptoms such as abdominal pain.•AP is diagnosed by laparotomy or radiologic studies such as CT in adults.•Duodenoduodenostomy may be an effective approach in managing of AP in adults.

Annular pancreas (AP) is a rare congenital anomaly that is not usually associated with symptoms in adults.

In symptomatic cases, AP causes non-specific symptoms such as abdominal pain.

AP is diagnosed by laparotomy or radiologic studies such as CT in adults.

Duodenoduodenostomy may be an effective approach in managing of AP in adults.