International Journal of Research in Medical Sciences | May 2020 | Vol 8 | Issue 5 Page 1 International Journal of Research in Medical Sciences Gupta A et al. Int J Res Med Sci. 2020 May;8(5):xxx-xxx www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Case Report Annular pancreas in adults: single unit experience from a tertiary care centre of Northern India Amit Gupta 1 *, Utkarsh Kumar 1 , Jaydeep Jain 1 , Ashikesh Kundal 1 , Natasha 1 , Deepak Rajput 1 , Navin Kumar 1 , Udit Chauhan 2 INTRODUCTION Annular pancreas is a rare anomaly in which a thin band of pancreatic tissue completely or partially encircles the second part of the duodenum resulting in varying degrees of obstruction. 1 It was initially believed that the majority of the cases of annular pancreas present early in life, but it has now been observed that it presents in equal frequency in both adults and children. In a case series of 103 patients with annular pancreas by Zyromski et al it was seen that 55 were adults and 48 were children. 2 In adults, the most common presentation was pain in 75% and only 11 % presented with obstructive symptoms. We present our experience of adult annular pancreas presenting as gastric outlet obstruction. CASE REPORT Case 1 A 27 year old gentleman presented to the Surgery outpatient department with complaints of recurrent episodes of non-bilious vomiting since one month. He also had history of altered blood vomiting 2 episodes in the past 1 month. There was no history of pain. He had not taken any long term medication. He had no history of any caustic ingestion. There was history of weight loss of 11 kg in last 6 months. He had no comorbidities. His BMI was 17.4 kg/square meter. Abdomen was scaphoid, umbilicus central and inverted, no scar/ sinus/ dilated veins/ visible peristalsis. On auscultation, succussion splash could be elicited. There was no free fluid in the abdomen. On evaluation, Hemoglobin was 8.2 g/dl, Total leukocyte count was 6700/cu.mm. Arterial blood gas revealed a pH of 7.38. His kidney function tests and liver function tests were within normal limits. An Upper GI endoscopy was done which showed a normal gastric mucosa with a tight stricture at the second part of duodenum and a dilated first part of duodenum and stomach. A contrast enhanced computed topography of the abdomen showed abrupt focal narrowing at the second part of duodenum and pancreas seen circumferential encasing this segment for a length of approximately 2.5 cm with maintained fat planes between the pancreas and the duodenum (Figure 1) CT 1 Department of Surgery, 2 Department of Radiology, AIIMS, Rishikesh, Uttarakhand, India Received: 23 March 2020 Accepted: 30 March 2020 *Correspondence: Dr. Amit Gupta, E-mail: dramit2411@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Annular pancreas is a rare congenital anomaly which usually presents with gastrointestinal symptoms early in life. In adults mostly it remains asymptomatic or may present with abdominal or features of duodenal obstruction the increased diagnosis of which is attributed to the improved imaging modalities. We hereby report our experience of adult annular pancreas in whom clinical presentation initially mimicked gastric or duodenal outlet obstruction. Adult annular pancreas was diagnosed with the aid of computed tomography of the abdomen and treated successfully with Roux-en-Y isoperistaltic gastrojejunostomy. Keywords: Adult annular pancreas, Gastric outlet obstruction, Gastrojejunostomy DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20201509