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- W4245440802 abstract "Introduction: Annular pancreas is a rare congenital anomaly that is sparingly reported with obstructive biliary symptoms. A 57-year-old female was referred to our facility with 2-week history of jaundice, dark urine, clay coloured stool, nausea, vomiting, and 25-pound weight loss over 3 months. Past history was significant for diabetes, hyperlipidemia, and cholecystectomy. Her medications include metformin, lisinopril, and simvastatin. Physical examination was unremarkable. Significant laboratory results were ALT of 599 U/L, AST of 534 IU/L, ALP of 113 U/L, total bilirubin of 14.8 μmol/L, CA 19-9 of 1498 U/mL. CT abdomen showed the head of the pancreas encasing the duodenum circumferentially (arrow), normal main pancreatic duct, liver architecture, and normal intra- and extrahepatic biliary ducts (Figure 1). Upper endoscopy revealed a focal mild concentric narrowing of the duodenum at the junction of first and second portion with normal mucosa. The endoscopic ultrasound (EUS) revealed a complete annular pancreas with normal common bile duct, main pancreatic duct (arrow), and normal duodenal ampulla (Figure 2). There were no malignant features in the duodenal mucosa, ampulla, or pancreas. Subsequently, her simvastatin was stopped with improvement of her symptoms; 3 weeks later, her LFTs were near baseline levels. EUS helps in detection of annular pancreas and also excluding coexistent pancreatobiliary malignancies and is shown to be of greater significance in detecting pancreatic structural abnormalities. Annular pancreas in adults can rarely present with obstructive symptoms. A series of 135 adult annular pancreas cases revealed only 1 case with biliary obstruction due to the pancreatic annulus. Thus, jaundice in adults with annular pancreas is usually associated with malignancies of ampulla, pancreas or the biliary tract, and, in a few cases as this one, could be just an innocent bystander.Figure 1Figure 2" @default.
- W4245440802 created "2022-05-12" @default.
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- W4245440802 date "2014-10-01" @default.
- W4245440802 modified "2023-09-30" @default.
- W4245440802 title "Annular Pancreas: Culprit or Innocent Bystander" @default.
- W4245440802 doi "https://doi.org/10.14309/00000434-201410002-01021" @default.
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