Annular pancreas

An annular pancreas is a ring of pancreatic tissue that encircles the duodenum (the first part of the small intestine). The normal position of the pancreas is next to, but not surrounding the duodenum.

Annular pancreas is problem present at birth (congenital defect). Symptoms occur when the ring of pancreas squeezes and narrows the small intestine so that food cannot pass easily or at all.

Newborns may have symptoms of complete blockage of the intestine. However, up to one half of people with this condition do not have symptoms until adulthood. There are also cases that are not detected because the symptoms are mild.

Conditions that may be associated with annular pancreas include:

Down syndrome
Excess amniotic fluid during pregnancy (polyhydramnios)
(polyhydramnios)
Polyhydramnios occurs when too much amniotic fluid builds up during pregnancy. It is also called amniotic fluid disorder, or hydramnios.
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Other congenital gastrointestinal problems
Pancreatitis

Symptoms

Newborns may not feed well. They may spit up more than normal, not drink enough breast milk or formula, and cry.

Adult symptoms may include:

Abdominal pain
Fullness after eating
Nausea or vomiting
Nausea or vomiting
Nausea is feeling an urge to vomit. It is often called "being sick to your stomach. "Vomiting or throwing-up forces the contents of the stomach up t...
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Exams and Tests

Tests include:

Abdominal ultrasound
Abdominal ultrasound
Abdominal ultrasound is a type of imaging test. It is used to look at organs in the abdomen, including the liver, gallbladder, spleen, pancreas, and...
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Abdominal x-ray
Abdominal x-ray
An abdominal x-ray is an imaging test to look at organs and structures in the abdomen. Organs include the liver, spleen, stomach, and intestines. Wh...
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CT scan
Upper GI and small bowel series
Upper GI and small bowel series
An upper GI and small bowel series is a set of x-rays taken to examine the esophagus, stomach, and small intestine. Barium enema is a related test th...
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Treatment

Treatment most often involves surgery to bypass the blocked part of the duodenum.

Outlook (Prognosis)

The outcome is most often good with surgery. Adults with an annular pancreas are at increased risk for pancreatic or biliary tract cancer.

Possible Complications

Complications may include:

Obstructive jaundice
Pancreatic cancer
Pancreatic cancer
Pancreatic cancer is cancer that starts in the pancreas.
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Pancreatitis (inflammation of the pancreas)
Peptic ulcer
Perforation (tearing a hole) of the intestine due to obstruction
Peritonitis
Peritonitis
Peritonitis is an inflammation (irritation) of the peritoneum. This is the thin tissue that lines the inner wall of the abdomen and covers most of t...
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When to Contact a Medical Professional

Contact your health care provider if you or your child has any symptoms of annular pancreas.

Open References

References

Maqbool A, Bales C, Liacouras CA. Intestinal atresia, stenosis, and malrotation. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 356.

Mehta MS, Barth BA, Husain SZ. Anatomy, histology, embryology, and developmental anomalies of the pancreas. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 55.

Semrin MG. Anatomy, histology, and developmental anomalies of the stomach and duodenum. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 49.

Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
Annular pancreas - illustration
Annular pancreas is an abnormal ring or collar of pancreatic tissue that encircles the duodenum (the part of the small intestine that connects to stomach). This portion of pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines. Symptoms from annular pancreas are nausea, vomiting, feeling of fullness after eating, and feeding problems in newborns. Surgical bypass of the obstructing segment of the duodenum is the usual treatment for this disorder.
Annular pancreas
illustration

Digestive system - illustration
The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.
Digestive system
illustration
Endocrine glands - illustration
Endocrine glands release hormones (chemical messengers) into the bloodstream to be transported to various organs and tissues throughout the body. For instance, the pancreas secretes insulin, which allows the body to regulate levels of sugar in the blood. The thyroid gets instructions from the pituitary to secrete hormones which determine the rate of metabolism in the body (the more hormone in the bloodstream, the faster the chemical activity; the less hormone, the slower the activity).
Endocrine glands
illustration
Annular pancreas - illustration
Annular pancreas is an abnormal ring or collar of pancreatic tissue that encircles the duodenum (the part of the small intestine that connects to stomach). This portion of pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines. Symptoms from annular pancreas are nausea, vomiting, feeling of fullness after eating, and feeding problems in newborns. Surgical bypass of the obstructing segment of the duodenum is the usual treatment for this disorder.
Annular pancreas
illustration

A Closer Look

Self Care

Tests for Annular pancreas

Review Date: 12/31/2023

Reviewed By: Jenifer K. Lehrer, MD, Department of Gastroenterology, Aria - Jefferson Health Torresdale, Jefferson Digestive Diseases Network, Philadelphia, PA. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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Health Library

Annular pancreas

Duodenum

(polyhydramnios)

Symptoms

Nausea or vomiting

Exams and Tests

Abdominal ultrasound

Abdominal x-ray

Upper GI and small bowel series

Treatment

Outlook (Prognosis)

Possible Complications

Pancreatic cancer

Peritonitis