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Ahmetgjekaj I, Roy P, Hyseni F, Mamillo K, Syed Z, Parisapogu A, Mian HS, Pakhrin S, Saha T, Tul kubra K, Maliha M, Musa J, Ghosh AS. Annular pancreas: Beneath the intestinal obstruction-A case report. Radiol Case Rep 2023; 18:1364-1367. [PMID: 36747589 PMCID: PMC9898573 DOI: 10.1016/j.radcr.2022.11.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 11/25/2022] [Accepted: 11/29/2022] [Indexed: 01/25/2023] Open
Abstract
Annular pancreas is an uncommon congenital anomaly which is a rare cause of congenital duodenal obstruction. It is normally identified during the neonatal period, but may also be identified in adolescence or adulthood. This diagnosis is often overlooked in adult patients who present with symptoms suggestive of duodenal obstruction. We present a case of AP detected in a 23-year-old man, with complaints of continuous vomiting and abdominal discomfort over the last 6 months. An upper gastrointestinal study revealed a constricted second part of the duodenum. A computed tomography scan revealed a complete ring of pancreatic tissue around the second part of the duodenum. Diagnostic and therapeutic surgery decompresses the external obstruction. The patient had an early post-operative activation. No specific guidelines and protocols exist about the management of such cases. Given the rarity of this congenital anomaly, presenting with chronic partial duodenal obstruction, and its successful surgical treatment, have prompted us to report the case along with a brief review of literature about the subject.
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Affiliation(s)
- Ilir Ahmetgjekaj
- University Clinical Center, Clinic of Radiology, Germia Campus Nazim Gafurri, 21 Dr. Shpëtim Robaj, Prishtina 10000, Kosovo,Corresponding author.
| | - Pooja Roy
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA,Internal Medicine Resident, Harlem Hospital Ctr-NY, New York, NY, USA
| | - Fjolla Hyseni
- Research Scientist/Sonographer, Department of Pediatrics, NYU Langone Health, New York, NY, USA
| | - Keti Mamillo
- Department of Anesthesiology, University Medical Center of Tirana “Mother Teresa”, Tirana, Albania
| | - Zaina Syed
- Biochemistry, Hunter College CUNY, New York, NY, USA
| | - Anusha Parisapogu
- Research Scholar in Department of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Hafsa Safeer Mian
- Department of Paediatrics, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan
| | | | - Tias Saha
- Honorary Medical Officer (HMO), Diabetic Association Medical College, Faridpur, Bangladesh
| | | | | | - Juna Musa
- Department of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Ammy Shankar Ghosh
- University of Science and Technology (USTC), Wayne State University, Michigan
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Zhang T, Yin SF, Wang QW, Feng WB, Ke CX. Case Report: The ectopic pancreas in the adrenal glands: It was found due to elevated blood pressure and initially diagnosed as adrenal adenoma. Front Surg 2022; 9:1040711. [PMID: 36406378 PMCID: PMC9669272 DOI: 10.3389/fsurg.2022.1040711] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022] Open
Abstract
Background The ectopic pancreas is a kind of congenital malformation formed during embryonic development, which has no anatomical relationship with the normal pancreas and is a rare solid disease. The ectopic pancreas in the adrenal glands is extremely rare. Case summary A 32-year-old man was admitted to the hospital after experiencing elevated blood pressure for 2 years as well as dizziness and blurred vision for 2 weeks. He had an elevated blood pressure of 170/110 mmHg (1 mmHg = 0.133 kPa) on physical examination 2 years ago, without palpitations, chest pain, and chest tightness. Two weeks ago, he presented with dizziness and blurred vision. Blood renin and aldosterone levels were elevated. Plain CT and contrast-enhanced CT scan showed nodular thickening of the left adrenal and homogeneous enhancement, which was initially considered adrenal adenoma. The postoperative pathology supported the ectopic pancreas in the left adrenal. After 78 months of postoperative follow-up, no recurrence was observed, but his blood pressure remained persistently high. Conclusion The ectopic pancreas occurring in the adrenal glands is extremely rare, has no specific clinical symptoms, and is mainly found for other reasons. It can easily be misdiagnosed as an adrenal adenoma. The final confirmation of the diagnosis still depends on the pathological biopsy. A great deal of reporting is still required for whether there is a correlation with elevated blood pressure.
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Affiliation(s)
- Tao Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Si-fan Yin
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Qi-wu Wang
- Department of Urology, The General Hospital of Western Theater Command, Chengdu, China
| | - Wen-bo Feng
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang-xing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Correspondence: Chang-Xing Ke
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Gerling KA, DesPain RW, Bradley MJ. Jejunal Mesenteric Heterotopic Pancreas Causing Necrotizing Pancreatitis and Small Bowel Obstruction. Am Surg 2022:31348221101508. [PMID: 35574662 DOI: 10.1177/00031348221101508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kimberly A Gerling
- The Department of Surgery, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Robert W DesPain
- The Department of Surgery, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Matthew J Bradley
- The Department of Surgery, 8395Walter Reed National Military Medical Center, Bethesda, MD, USA
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CHRONIC PANCREATIC DISEASE IN THE LESSER KUDU ( TRAGELAPHUS IMBERBIS): A REPORT OF 16 CASES IN THE UNITED STATES. J Zoo Wildl Med 2021; 52:580-591. [PMID: 34130401 DOI: 10.1638/2020-0186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/21/2022] Open
Abstract
A review of archival cases at Northwest ZooPath from 1995-2018 identified 16/96 (17%; eight females, eight males) lesser kudus (Tragelaphus imberbis) with chronic pancreatic disease (CPD) from three institutions, all of which originated from an initial founder stock of 12 animals. Ages at time of death or euthanasia ranged from 2 to 132 mo (average age = 69 mo). All cases had varying degrees of pancreatic acinar cell depletion, ductular hyperplasia, and fibrosis. Serum fructosamine, glucose, insulin, and insulin to glucose ratio collected close to time of death from 13 affected animals were not significantly different from controls (n = 19). Of these analytes, receiver operating characteristic analysis identified fructosamine as the best-performing analyte with an area under the curve 0.671 (95% confidence interval = 0.480-0.828; sensitivity = 58.3%, specificity = 84.2%; cutoff point >352 µmol/L) in the diagnosis of CPD. With a 15% prevalence, there was a positive predictive value of 41% and a negative predictive value of 92%, indicating that the probability of false positives is high, but of false negatives is low. An etiologic agent was not identified by histology (n = 16), transmission electron microscopy (n = 1), or enterovirus PCR (n = 2). Serum zinc and hepatic heavy metal analyses were judged to be within normal limits. Chronic pancreatic disease is considered an important cause of morbidity and mortality in the lesser kudu; serum chemistry analysis warrants further investigation in its use for diagnosis. The etiopathogenesis is not understood, but the absence of obvious causes, the occurrence also in very young animals, and the inbred lineage of lesser kudus in the United States suggest a genetic basis for this disease.
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Yi D, Ding XB, Dong SS, Shao C, Zhao LJ. Clinical characteristics of adult-type annular pancreas: A case report. World J Clin Cases 2020; 8:5722-5728. [PMID: 33344566 PMCID: PMC7716324 DOI: 10.12998/wjcc.v8.i22.5722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 08/24/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Annular pancreas (AP) is a rare congenital abnormal rotation of the pancreas. AP rarely occurs in adults. Pancreatic tumors and ampullary tumors are related to AP, so the discovery and treatment of AP are essential.
CASE SUMMARY This study investigated the clinical manifestations, imaging features, complications, and treatment of six patients diagnosed with AP at the Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jilin University from January 2010 to June 2020. There were four males and two females, with an average age of 56.00 ± 9.86 years old. In this study, abdominal pain and jaundice were the main clinical manifestations. Imaging can show the “crocodile jaw sign” or “double bubble sign”.
CONCLUSION For patients with duodenal or biliary obstruction, physicians should give priority to AP when imaging examinations suggest that the duodenum is wrapped with tissue similar to the density of the pancreas. Symptomatic patients should actively undergo surgical treatment.
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Affiliation(s)
- Dan Yi
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Bo Ding
- Department of Radiology, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Shan-Shan Dong
- Department of Hepatobiliary and Pancreatic Surgery, First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Chen Shao
- Department of Pathology, Beijing You’an Hospital, Beijing 100069, China
| | - Li-Jing Zhao
- Department of Rehabilitation, School of Nursing, Jilin University, Changchun 130021, Jilin Province, China
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