Annular Pancreas with Intestinal Malrotation in 12 Years’ Girl: A Rare Case Report

Abstract

Annular pancreas is a congenital anomaly characterized by the presence of a ring of pancreatic tissue that partially or completely encircles the second part of the duodenum. This condition results from the failure of the vertical pancreatic bud to rotate properly, leading to its elongation and encircling of the upper section of the duodenum. The first description of annular pancreas was made by Tiedemann in 1818, and the term "Annular pancreas" was coined by Ecker in 1982. In the normal development of the pancreas, the dorsal and ventral pancreatic buds fuse during the first 4-8 weeks of embryonic life. In cases of annular pancreas, the ventral bud fails to rotate as it should, causing it to elongate and encircle the upper part of the duodenum. This condition can affect individuals from neonates to the elderly, making it challenging to diagnose. Diagnosing annular pancreas can be accomplished through various methods, including preoperative procedures such as upper GI endoscopy, Barium meal follow-through, CT and MRI scans, ERCP (endoscopic retrograde cholangiopancreatography), and endoscopic ultrasonography (EUS). In approximately 40% of cases, surgical intervention is necessary to confirm the diagnosis. We present a rare case of annular pancreas in a 12-year-old girl who also had intestinal malrotation. She was experiencing frequent episodes of vomiting. Her diagnosis was confirmed through a Barium meal follow-through, which revealed a typical "Double bubble" sign. She underwent a gastrojejunostomy and a modified Ladd's operative procedure to address the condition.