Portal Annular Pancreas: Prevalence and Surgical Importance

To determine the prevalence of portal annular pancreas (PAP) in a defined population using multidetector computed tomography (CT) and to assess its potential surgical implications, and to report our experience of three cases.

A retrospective analysis was conducted on 1000 consecutive triphasic contrast-enhanced abdominal CT scans performed between June 2024 and January 2025, evaluating the presence and subtype of PAP.

PAP was identified in 27 patients (2.7%). The suprasplenic variant was the most common (n = 25), followed by the mixed variety (n = 2). Of the affected individuals, 10 were male and 17 were female. We have noticed three cases of PAP, out of 85 pancreatic resections. One patient underwent Pancreaticoduodenectomy with complete excision of annular part. Other two patients underwent distal pancreatectomy, where annular part was stapled.

PAP, though often asymptomatic, is a critical anatomical variant that carries significant implications for pancreatic resections and outcomes. While its reported prevalence varies, our study suggests that it is not as rare as once believed. Under-recognition of PAP can contribute to higher rates of postoperative pancreatic fistula. The PAP which requires pancreatic resections can be best managed by preoperative identification in the image, meticulous anastomosis depending on the location, stapler resection of annular pancreas, complete excision of annular part, properly placed drain and postoperative vigilance for pancreatic fistula. Radiologists and surgeons must maintain a high index of suspicion and collaborate closely during preoperative evaluations to reduce intraoperative surprises and optimize surgical outcomes.