Annular Pancreas

Written by Darla Burke | Published on July 11, 2012
Medically Reviewed by George Krucik, MD

Annular Pancreas

The pancreas is an organ that is located in the posterior (back) of your abdomen. It is connected by a duct to a part of the small intestine called the duodenum. The pancreas aids in the digestion of food. It is responsible for excreting insulin into the bloodstream to transform glucose into energy. It also secretes enzymes into the intestines to directly aid in the digestion of food.

Normally, your pancreas sits next to your duodenum in your abdomen. In some people, tissue from the pancreas may surround the duodenum. When this happens, your duodenum can become restricted or blocked. This may impact your ability to digest food. This condition is known as annular pancreas.

What Causes Annular Pancreas?

Annular pancreas is a congenital condition. This means that it is present at birth. Although doctors do not know what causes the disorder, annular pancreas is associated with other congenital disorders, including:

  • Down syndrome
  • tracheoesophageal fistula—an abnormal connection (fistula) between the esophagus and the trachea
  • intestinal atresia—the failure of a portion of the intestinal tract to completely form
  • pancreas divisum—birth defect in which ducts of the pancreas fail to join together

Annular pancreas has also been associated with polyhydramnios (excess amniotic fluid during pregnancy). Annular pancreas is a rare condition that occurs in only one in every 20,000 newborns. It more frequently occurs in males (Jarry et al., 2011).

What Are the Symptoms of Annular Pancreas?

Symptoms of annular pancreas develop when tissue from the pancreas squeezes the small intestine. In some people, the tissue that surrounds the duodenum may be so small that it does not cause any symptoms. This happens in half of all patients with this condition.

In other cases, the pancreatic tissue surrounding the small intestine causes a blockage that can make it difficult for a person to eat. Infants who are affected by annular pancreas may

  • cry
  • spit up more than normal
  • be unable to drink enough formula or breast milk

Sometimes symptoms of annular pancreas do not develop until adulthood. When symptoms occur, they may include:

  • fullness after eating
  • nausea or vomiting

How Is Annular Pancreas Diagnosed?

Your doctor will be able to diagnose annular pancreas. If you have symptoms of this disorder, your doctor will ask you about your health history, including underlying congenital problems that you have or had in the past. Your doctor may need to order several tests to confirm your diagnosis. Tests used to confirm a diagnosis of annular pancreas include:

  • ultrasound of the abdomen
  • X-ray of the abdomen
  • computed tomography (CT) scan
  • upper gastrointestinal (GI) series
  • small bowel series

How Is Annular Pancreas Treated?

Your doctor may recommend surgery to bypass the pancreatic tissue. The goal of treatment is to remove the obstruction so that your small intestine can function normally. Typically, the pancreatic tissue cannot be removed from the duodenum. Destruction of the pancreatic tissue can cause damage to the pancreas.

Surgical options for annular pancreas include gastrojejunostomy or duodenojejunostomy. These procedures will require your doctor to cut the intestine at the site of the blockage and reconnect the two parts of the intestine in an area below the obstruction.

What Is the Long-Term Outlook for a Patient with This Condition?

If you are diagnosed with annular pancreas, you will need surgery to correct the problem. Following surgery, your recovery and long-term outlook should be quite good. If you are diagnosed with annular pancreas as an adult, you’re at higher risk for complications from the disorder. Complications may include:

  • obstructive jaundice—obstruction in the flow of bile
  • pancreatitis—inflammation of the pancreas
  • peptic ulcer—a defect in the lining of the stomach or the first part of the intestine
  • perforation (hole) in the intestine
  • peritonitis—inflammation of the tissue that lines the inner wall of the abdomen

In addition, adults who have annular pancreas have a higher risk for developing certain types of cancer, including biliary tract and pancreatic cancer.

How Can Annular Pancreas Be Prevented?

You cannot prevent annular pancreas. The condition occurs due to genetic changes during fetal development. However, there are steps you can take to have a healthy pregnancy and a healthy baby:

  • Maintain a healthy diet during pregnancy, including fruits, vegetables, and whole grains.
  • See your doctor regularly for prenatal check-ups.
  • Stop smoking or do not start smoking.
  • Do not consume drugs that are not prescribed by your doctor or alcohol.
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