Annular pancreas: dramatic differences between children and adults.

Area of Science:

• Gastroenterology
• Pediatric Surgery
• Surgical Oncology

Background:

• Annular pancreas is a rare congenital anomaly with limited comparative analysis between pediatric and adult populations.
• Recent advancements in prenatal diagnosis and imaging have increased the detection and management experience of annular pancreas.
• This study addresses the rarity of annular pancreas by analyzing a cohort of 103 patients.

Purpose of the Study:

• To compare the clinical presentation, management, and outcomes of annular pancreas in children versus adults.
• To identify distinct patterns of associated anomalies and complications between pediatric and adult patients.
• To provide insights into the differing disease spectrum of annular pancreas across age groups.

Main Methods:

• A retrospective review of 103 patients (48 children, 55 adults) diagnosed with annular pancreas between 1992 and 2006.
• Exclusion of patients with isolated duodenal atresia, stenosis, or webs.
• Comparison of demographic data, clinical presentation, associated anomalies, surgical management, and outcomes between pediatric and adult cohorts.

Main Results:

• Children diagnosed at a median age of 1 day, with 71% having congenital anomalies (e.g., Down syndrome, cardiac, intestinal).
• Adults diagnosed at a median age of 47 years, presenting with pain, vomiting, pancreatitis, or abnormal liver tests.
• Adults showed higher rates of pancreas divisum (29%), pancreatobiliary neoplasia (11%), and required more pancreatobiliary procedures (67%) compared to children.

Conclusions:

• Annular pancreas exhibits a distinct spectrum of disease in children and adults.
• Congenital anomalies are significantly more prevalent in pediatric cases of annular pancreas.
• Adults with annular pancreas are more prone to complex pancreatobiliary disorders and malignancy.