Annular pancreas: the failure of side-to-side gastrojejunostomy anastomosis and the success of repair with Roux-en-Y gastrojejunostomy

  • Isaac A. Deswanto Department of Surgery, Tarakan General Hospital, Tarakan, North Kalimantan
  • Janta F. Barus Department of Surgery, Tarakan General Hospital, Tarakan, North Kalimantan
Keywords: annular pancreas, infant, Roux-en-Y gastrojejunostomy, side-to-side gastrojejunostomy


Annular pancreas is a rare congenital anomaly characterized by a partial or complete encirclement of ectopic pancreas tissue around the duodenum. We report a case of annular pancreas in a 15 day-old infant admitted to the hospital with complaints of profuse and recurrent vomiting and loss of body weight. Non-contrast abdominal X-ray showed a dilated stomach with bubbles formation around the upper abdomen. An obstruction was noted and open laparotomy was performed. Upon laparotomy, pancreatic ring encircled the proximal duodenum causing an obstruction. Side-to-side gastrojejunostomy was performed and passage through the bypass was satisfactory. Four days after the operation, vomiting and bulging abdomen ensued. Contrast abdominal X-ray demonstrated filling defects at the level of obstruction and the anastomosis made. Anastomotic stricture was suspected and thus was corrected using Roux-en-Ygastrojejunostomy procedure. Postoperative course in this patient was satisfactory and patient was discharged after 24 days of hospitalization.

Author Biography

Janta F. Barus, Department of Surgery, Tarakan General Hospital, Tarakan, North Kalimantan
The Head of Surgery Department of RSUD Tarakan, Tarakan, North Kalimantan


Fu PF, Yu JR, Liu XS, Shen QY, Zheng SS. Symptomatic adult annular pancreas: report of two cases and a review of the literature. Hepatobiliary Pancreat Dis Int. 2005;4(3):468-71.

White J, Wilson J. USMLE Step 1 Anatomy Lecture Notes. Kaplan Medical. 2011: 247-8 p.

Türkvatan A, Erden A, Türkoğlu MA, Yener O. Congenital variants and anomalies of the pancreas and pancreatic duct: imaging by magnetic resonance cholangiopancreaticography and multidetector computed tomography. Korean J Radiol. 2013;14(6):905-13.

Mahdi B, Selim S, Hassen T, Mongi MM, Fadhel CM, Fathi C, et al. A rare cause of proximal intestinal obstruction in adults - annular pancreas: a case report. Pan Afr Med J. 2011;10:56.

Mulugeta PG, Hilmes MA. Annular pancreas in a toddler. Pediatr Radiol. 2010;40(Suppl1):S106.

Pansini M, Magerkurth O, Haecker FM, Sesia SB. Annular pancreas associated with duodenal obstruction. BMJ Case Reports. 2012;10:1-2.

Bouassria A EH, Elbouhaddouti H, Mouaqit O, Benjelloun E B, Ousadden A, Mazaz K, et al. Annular pancreas producing duodenal obstruction: A case report. Open J Gastroenterol. 2013;3(3):202-4.

Zeineb M, Sadri BA, Nizar M, Hassen H, Nafaa A, Taher K. Annular pancreas intra operatively discovered: a case report. Clin Pract. 2011;1(4):e82. doi: 10.4081/cp.2011.e82

Patra DP, Basu A, Chanduka A, Roy A. Annular pancreas: a rare cause of duodenal obstruction in adults. Indian J Surg. 2011;73(2):163-5.

Tas A, Köklü S, Kocak E, Akbal E, Ergul B. An unusual cause of acute pancreatitis: annular pancreas and papillary opening of the cystic duct. Gut Liver. 2012;6(3):403-4.

Kandpal H, Bhatia V, Garg P, Sharma R. Annular pancreas in an adult patient: diagnosis with endoscopic ultrasonography and magnetic resonance cholangiopancreatography. Singapore Med J. 2009;50(1):e29-31.

Demirdöven M, Yazgan H, Korkmaz M, Gebeşçe A, Tonbul A. Smith-lemli-opitz syndrome: a case with annular pancreas. Case Rep Pediatr. 2014;2014:623926.

Dankovcik R, Jirasek JE, Kucera E, Feyereisl J, Radonak J, Dudas M. Prenatal diagnosis of annular pancreas: reliability of the double bubble sign with periduodenal hyperechogenic band. Fetal Diagn Ther. 2008;24(4):483-90.

Whittingham-Jones PM, Riaz AA, Clayton G, Thompson HH. Annular pancreas - a rare cause of gastric obstruction in an 82-year-old patient. Ann R Coll Surg Engl. 2005;87(1):W13-5.

Alahmadi R, Almuhammadi S. Annular pancreas: a cause of gastric outlet obstruction in a 20-year-old patient. Am J Case Rep. 2014;15:437-40.

Ezomike UO, Ekenze SO, Amah CC. Outcomes of surgical management of intestinal atresias. Niger J Clin Prac. 2014;17(4):479-83.

Kaddah SN, Bahaa-Aldin KHK, Aly HF, Hassan HS. Congenital duodenal obstruction. Ann Pediatr Surg. 2006;2(2):130-5.

How to Cite
Deswanto IA, Barus JF. Annular pancreas: the failure of side-to-side gastrojejunostomy anastomosis and the success of repair with Roux-en-Y gastrojejunostomy. Med J Indones [Internet]. 2015Jun.23 [cited 2024Feb.22];24(2):115-9. Available from:
Case Report/Series