Q45.1

Clinical Causes: This condition results from abnormal development of the pancreas during fetal growth, specifically during the rotation and fusion processes of the pancreatic buds. The exact reason why the pancreatic tissue encircles the duodenum is not fully understood, but it's believed to involve genetic factors and intrauterine developmental issues. Annular pancreas often appears sporadically but can sometimes be associated with other congenital abnormalities.

Key Symptoms: Feeding difficulties in newborns, including poor feeding and vomiting Bile-stained vomit indicating potential blockage of duodenum Abdominal distension and bloating Failure to gain weight or grow properly In older children and adults: nausea, vomiting, abdominal pain, especially after meals Signs of intestinal blockage, such as constipation or absence of bowel movements

Diagnosis Path: Initial assessment includes physical examination and review of symptoms Imaging studies are crucial for confirmation: — Abdominal X-rays can reveal signs of intestinal obstruction — An upper gastrointestinal series with barium swallow allows visualization of the duodenum and may show narrowing or obstruction — Endoscopic procedures can provide direct visualization and sometimes therapeutic options — Modern imaging such as abdominal ultrasound or CT scan can help identify the pancreatic tissue encircling the duodenum

Treatment Protocols: Surgical intervention is often necessary to relieve the obstruction: — The most common procedure is a bypass surgery, such as duodenojejunostomy, which creates an alternative pathway for food to pass — In some cases, excision of the annular tissue can be performed if feasible Postoperative care involves monitoring for complications and ensuring proper nutrition In adults with milder symptoms, conservative management may be considered, although surgical correction remains the standard approach for significant obstruction Supportive care includes addressing nutritional needs and managing any associated conditions