[Annular pancreas in the adult (author's transl)]

Annular pancreas--a congenital malformation consisting of a ring of pancreatic tissue around the second part of the duodenum--is a rare surgical condition in adults. It may be responsible for occlusion in the newborn, but frequently remains latent or does not reveal itself until adulthood, usually around the age of 40. The only symptoms are ulcer-like epigastric pains; vomiting occurs at a late stage and jaundice irregularly. Hypotonic duodenography shows, at best, duodenal stenosis, the extrinsic origin of which is disclosed by fiberoscopy. Pre-operative investigations should aim at detecting a gastro-duodenal ulcer or an associated chronic pancreatitis. Owing to the presence of an excretory duct within the ring, section of the latter entails a risk of fistulisation. The best prospects of cure are offered by digestive tract derivation procedures: latero-lateral duodeno-duodenostomy, gastro-enterostomy and duodeno-jejunostomy on a Y-shaped excluded jejunal loop.