Transplantation of an annular pancreas with enteric drainage

Annular pancreas (AP) is an uncommon congenital anomaly which often does not become symptomatic until late life. We report a case of successful transplantation of an AP in a type I IDDM woman. The whole pancreas with a duodenal cuff was procured from a 41-year-old previously healthy female. The AP was identified at the time of procurement and did not appear to have caused any significant duodenal obstruction. The graft was transplanted on the external iliac vessels and the exocrine secretions were drained enterically. In order to avoid any possible injury to the ductal system, a side-to-side duodenojejunal anastomosis was fashioned using the first and the second portion of the duodenum, leaving about 2 cm of free duodenal margin proximal to the pancreatic ring. The postoperative course was uneventful and at 1 month graft function is unremarkable. Although challenging from a technical point of view, transplantation of an AP is a safe procedure which allows good results. Given the limited number of organ donors and the difficulty in HLA-matching, every AP should be considered suitable for transplantation.