Symptomatic annular pancreas in newborns

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Medical Genetics

Background:

• Annular pancreas is a congenital anomaly where pancreatic tissue encircles the duodenum.
• It is the most common anomaly of the pancreas, often presenting in infancy.
• Associated anomalies are frequent and impact clinical presentation and management.

Purpose of the Study:

• To describe the clinical features of seven infants diagnosed with annular pancreas.
• To analyze associated anomalies and surgical outcomes.
• To evaluate the relationship between annular pancreas, duodenal obstruction, and prematurity.

Main Methods:

• Retrospective analysis of seven newborns surgically treated for annular pancreas between 1990 and 1998.
• Evaluation of birth weight, gestational age, symptoms, diagnostic methods, co-occurring anomalies, and surgical interventions.
• Comparison of surgical techniques: duodenoduodenostomy (DD) versus DD with tapering enteroplasty (TE) and transanastomotic jejunal tube (TJT).

Main Results:

• Mean birth weight was 2385g, mean gestational age 37.5 weeks.
• Associated anomalies included intestinal malrotation (42.8%), duodenal obstruction (28.5%), trisomy 21 (14.2%), cardiac malformation (14.2%), and Meckel's diverticulum (14.2%).
• Duodenoduodenostomy was performed in four patients; three underwent DD with TE and TJT.

Conclusions:

• Infants with annular pancreas and duodenal obstruction are often premature or small for gestational age.
• Symptoms result from extrinsic compression and intrinsic duodenal stenosis.
• Annular pancreas is strongly associated with intestinal malrotation, less so with trisomy 21 compared to duodenal atresias.
• Oral feeding tolerance was similar between surgical groups.