From duodenitis to stricture: Decoding the impact of partial annular pancreas over years

Partial annular pancreas (PAP) is the rarer variant of annular pancreas with unknown prevalence, and is characterised by ring of pancreatic tissue partially surrounding the duodenum. PAP are frequently asymptomatic, however, symptoms may only arise in adulthood, manifesting as pancreatitis, duodenal ulceration, or, less commonly, biliary obstruction or intermittent bowel obstruction. It is often overlooked on radiological examinations due to its subtle manifestations. Even asymptomatic individuals are at risk of intestinal obstruction and pancreatitis, underscoring the importance of regular follow-up in management. Treatment should be tailored to the specific complications present. This case report bring forth the case of a adult male with complaints of long standing intermittent gastric outlet obstruction, with underlying duodenal ulcer and duodenitis, secondary to PAP, which eventually progressed to duodenal stricture requiring surgical management, despite conservative management. Highlighting the impact of partial annular pancreas over the years, with progression of a inflammatory disease to mechanical obstruction. Thus underlining importance of early recognition and prompt surgical management of symptomatic PAP patient, to prevent development of complication in later course of the disease.