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shaped like a ring (同)annulate, annulated, circinate, ringed, ring-shaped, doughnut-shaped
a large elongated exocrine gland located behind the stomach; secretes pancreatic juice and insulin

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/12/08 23:19:06」(JST)

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Annular pancreas is a rare condition in which the second part of the duodenum is surrounded by a ring of pancreatic tissue continuous with the head of the pancreas. This portion of the pancreas can constrict the duodenum and block or impair the flow of food to the rest of the intestines. It is estimated to occur in 1 out of 12,000 to 15,000 newborns.^[1] The ambiguity arises from the fact that not all cases are symptomatic.^[2]

Causes[edit]

It is typically associated with abnormal embryological development, however adult cases can develop. It can result from growth of a bifid ventral pancreatic bud around the duodenum, where the parts of the bifid ventral bud fuse with the dorsal bud, forming a pancreatic ring. It can also result if the ventral pancreatic bud fails to fully rotate, so it remains on the right or if the dorsal bud rotates in the wrong direction, such that the duodenum is surrounded by pancreatic tissue. Blockage of the duodenum develops if inflammation (pancreatitis) develops in the anular pancreas.

Presentation[edit]

Early signs of abnormality include polyhydramnios (an excess of amniotic fluid), low birth weight, and feeding intolerance immediately after birth.

Diagnosis[edit]

Postnatal diagnostic procedures include abdominal x-ray and ultrasound, CT scan, and upper GI and small bowel series.

Treatment[edit]

Treatment usually is bypassing the obstructed segment of duodenum by duodeno-duodenostomy. Another approach is laparoscopic gastrojejunostomy.^[3]

References[edit]

^ Lainakis N, Antypas S, Panagidis A et al. (2005). "Annular pancreas in two consecutive siblings: an extremely rare case". European Journal of Pediatric Surgery 15 (5): 364–8. doi:10.1055/s-2005-865838. PMID 16254852.
^ Ravitch, MM. (1975). "The pancreas in infants and children". Surg Clin North Am 55 (2): 377–85. PMID 165579.
^ De Ugarte DA, Dutson EP, Hiyama DT (2006). "Annular pancreas in the adult: management with laparoscopic gastrojejunostomy". The American surgeon 72 (1): 71–3. PMID 16494188.

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1. 輪状膵 annular pancreas
2. 膵管癒合不全の解剖学および臨床的意義 anatomy and clinical significance of pancreas divisum
3. 消化管閉鎖症および閉塞の出生前診断 prenatal diagnosis of gastrointestinal atresia and obstruction
4. 成人における胃流出路閉塞 gastric outlet obstruction in adults
5. 消化管の発達に関する概要 overview of the development of the gastrointestinal tract

English Journal

Endoscopic Ultrasonography May Select Subjects Having Asymptomatic Chronic Pancreatic Hyperenzymemia Who Require a More Strict Follow-up.

Antonini F1, Belfiori V, Pagano N, Buscarini E, De Minicis S, Lo Cascio M, Marraccini B, Piergallini S, Rossetti P, Andrenacci E, Macarri G, Pezzilli R.
Pancreas.Pancreas.2017 Feb 14. doi: 10.1097/MPA.0000000000000796. [Epub ahead of print]
OBJECTIVES: We have previously shown that at least 50% of patients having asymptomatic chronic pancreatic hyperenzymemia (ACPH) may develop morphological pancreatic alterations. Endoscopic ultrasonography (EUS) may detect small lesions, and its sensitivity seems to be higher than other imaging techn
PMID 28196017

Circumportal Pancreas-a Must Know Pancreatic Anomaly for the Pancreatic Surgeon.

Luu AM1, Braumann C2, Herzog T2, Janot M2, Uhl W2, Chromik AM3.
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract.J Gastrointest Surg.2017 Feb;21(2):344-351. doi: 10.1007/s11605-016-3315-8. Epub 2016 Nov 8.
PURPOSE: Circumportal pancreas is a rare congenital pancreatic anomaly with encasement of the portal vein and/or the superior mesenteric vein by pancreatic tissue. It is often overlooked on cross-sectional imaging studies and can be encountered during pancreatic surgery. Pancreatic head resection wi
PMID 27826941

Portal Annular Pancreas: A Rare and Overlooked Anomaly.

Mittal P1, Gupta R1, Mittal A1, Ahmed A2.
Polish journal of radiology.Pol J Radiol.2017 Jan 24;82:38-40. doi: 10.12659/PJR.899733. eCollection 2017.
BACKGROUND: Portal annular pancreas is a rare pancreatic developmental anomaly which is often overlooked at imaging, and often diagnosed retrospectively when it is detected incidentally at the time of surgery. Although the anomaly itself is asymptomatic, it becomes important in cases where pancreati
PMID 28203311

Japanese Journal

閉塞性黄疸を契機に発見された輪状膵合併膵癌の1例

Progress of Digestive Endoscopy 88(1), 188-189, 2016
NAID 130005161993

門脈輪状膵を伴った膵頭部癌の1例

日本臨床外科学会雑誌 76(8), 2037-2040, 2015
NAID 130005128308

門脈輪状膵にreplaced―右肝動脈を伴った十二指腸乳頭部癌の1例

日本臨床外科学会雑誌 76(4), 890-894, 2015
NAID 130005106572

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