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Case Report | Surgery | Volume 15 Issue 8, August 2026 | Pages: 1861 - 1867 | India
Incomplete Annular Pancreas Presenting as Gastric Outlet Obstruction in an Adult: A Rare Case Report, Surgical Management, and Comprehensive Review of Literature
Abstract: Background: Annular pancreas is a rare congenital anomaly characterized by a band of pancreatic tissue partially or completely surrounding the second part of the duodenum. While typically diagnosed in neonates, adult presentation is exceedingly rare and often poses a diagnostic dilemma. Symptoms in adults usually manifest due to gastric outlet obstruction (GOO), peptic ulcer disease, or pancreatitis. Case Presentation: We report the case of a 54-year-old male who presented to the emergency department with a 5-day history of progressively worsening postprandial abdominal pain and projectile bilious vomiting containing food particles. He had a known medical history of Type 2 Diabetes Mellitus and hypertension. Clinical examination revealed a scaphoid abdomen with epigastric tenderness. Contrast-enhanced computed tomography (CECT) of the abdomen revealed pancreatic tissue extending antero-laterally to the second part of the duodenum, causing minimal compression and resulting in upstream dilatation of the first part of the duodenum and stomach, consistent with an incomplete annular pancreas. Management: Following initial resuscitation and gastric decompression, the patient underwent an exploratory laparotomy. Intraoperative findings confirmed an incomplete ring of pancreatic tissue compressing the duodenum with marked gastric and proximal duodenal dilatation. To relieve the obstruction without risking pancreatic fistula or stricture- complications associated with dividing the pancreatic ring- an open gastrojejunostomy with a side-to-side jejunojejunostomy was performed. Outcome: The postoperative course was uneventful. The patient tolerated gradual dietary escalation and was discharged on postoperative day seven. Follow-up at three months showed complete resolution of symptoms and weight gain. Conclusion: Adult-onset incomplete annular pancreas is a rare but critical differential diagnosis for GOO. Accurate preoperative radiological assessment, particularly with CECT, is vital. Surgical bypass, rather than division of the pancreatic annulus, remains the safest and most definitive treatment modality to relieve obstruction and avoid catastrophic pancreaticobiliary complications.
Keywords: Annular Pancreas, Gastric Outlet Obstruction, Congenital Anomaly, Duodenal Obstruction, Gastrojejunostomy, Adult Presentation, Case Report, Surgical Bypass
How to Cite?: Dr. Venkatesan K, Dr. Aravind, Dr. Krutarth Thakkar, Dr. Kalyan Yeddula, "Incomplete Annular Pancreas Presenting as Gastric Outlet Obstruction in an Adult: A Rare Case Report, Surgical Management, and Comprehensive Review of Literature", Volume 15 Issue 8, August 2026, International Journal of Science and Research (IJSR), Pages: 1861-1867, https://www.ijsr.net/getabstract.php?paperid=MR26826120806, DOI: https://dx.doi.org/10.21275/MR26826120806