Duodenal Obstruction from Annular Pancreas Managed with Roux-en Y Limb in Adult: A Rare Case Report

Abstract

Annular pancreas is an uncommon congenital disorder, first reported in 1818. This is a rare anomaly. Careful navigation through this complex clinical scenario is needed for precise evaluation and better management strategies— A 54-year-old diabetic male presented with manifestations of progressive emesis which is non-bilious and reduced weight. Investigative findings indicated an annular pancreas that caused gastric outlet obstruction. Due to the worsening of the obstructive symptoms operative management was preferred.  Intraoperatively pancreatic tissue was visualized encasing the 2nd part of the duodenum circumferentially with enlargement of the 1st part of the duodenum and stomach proximally. A Duodeno-Jejunostomy with the Roux limb was performed, resolving the symptoms. Symptomatology varies based on the age of presentation in the annular pancreas. Surgical bypass procedures successfully alleviate the obstruction and ensure excellent results. Adults suffering from upper GI obstruction might consider the annular pancreas in differentials.