Annular pancreas is a congenital malformation but manifestations can appear in the adult life.
Annulus means a ring of pancreatic tissue around the duodenum. For annular pancreas to be diagnosed, this ring can be complete or incomplete.
Embryological basis
Normally the ventral buds of pancreas and dorsal bud fuses together. Non rotation and fusion of these two leads to the formation of annular pancreas. It envelops the 2nd part of duodenum.
Age of presentation
Incidence is equal in both adults and children
Presentation in children is congenital anomalies and duodenal obstruction
Presents in adults as pancreatitis usually in 3rd or 4th decade
Association with other pancreatic conditions
1. Pancreas divisum 35- 40%
2. Chronic pancreatitis 45- 50%
Other GI conditions
Annular pancreas is a possible etiology of congenital duodenal obstruction and is associated with other congenital anomalies such as Down syndrome, duodenal atresia, and imperforate anus.
Clinical Fetaures
Of those seen as adults, 75%were seen with pain
22% were diagnosed with pancreatitis
24%) had gastrointestinal (GI) symptoms that included vomiting,
11%had obstructive jaundice and/or abnormal liver function test results.
Treatment
It is duodenal bypass and not resection of duodenum as duodenum excision can lead to pancreatitis
in children its duodeno - duodenostomy
in adults duodenoduodenostomy which has now replaced duodenojejunostomy
Pancreas annulare in radiology refers to the imaging findings of a rare congenital anomaly where a ring of pancreatic tissue encircles the duodenum. On imaging, such as CT, MRI, or endoscopic ultrasound, it may present as a characteristic encircling or constricting mass around the duodenum, often associated with symptoms like duodenal obstruction.
The BISAP score (Bedside Index for Severity in Acute Pancreatitis) is used to predict the severity of acute pancreatitis. It includes 5 components, one point each:
Blood urea nitrogen (BUN) > 25 mg/dL
Impaired mental status (GCS < 15)
Systemic Inflammatory Response Syndrome (SIRS)
Age > 60 years
Pleural effusion on imaging
✅ WBC >16,000 is not directly part of the BISAP score, although it is a criterion within SIRS, which is part of BISAP.
Q) All are true about pancreatic protocol CT except (#AIIMS )
a) > 90% of un resect able lesions are picked up by CT
b) It is a dual phase CT with cuts taken at 40 secs and 70 secs
c) Liver metastasis are detected in early arterial phase
d) All are true
Ans c
Pancreatic protocol CT involves imaging at the pancreatic phase (i.e., approximately 45 seconds after contrast administration) and at the portal venous phase (i.e., approximately 70 seconds after contrast administration).
It is useful for detection of adenocarcinoma of pancreas.
Metastatic lesions are seen in the portal venous phase, because the lesions are not typically well vascularized.
Arterial phase images are principally used to distinguish metastatic disease from benign vascular lesions, such as hemangiomas, or to better define the arterial anatomy of the liver.
Non contrast phase used for
Evaluation of pancreatic calcifications and allows localization of the precise levels for imaging on the post contrast study.
Early arterial phase
Evaluation of pancreatic vasculature without interference from venous opacification.
Late Arterial Phase
Distinguish pancreatic neoplasms from adjacent normal pancreatic tissue It also is useful to evaluate hypervascular liver metastases as seen in patients with neuroendocrine tumors of the pancreas.
Portal Phase
Evaluate for hypovascular liver metastases
Ref Blumgart
The dedicated pancreas protocol uses 750 to 1000 mL of oral water as a negative contrast agent administered before the examination, to aid distinction of enhanced vessels from the
gastrointestinal tract
enlargement of the pancreas with loss of definition of the borders of the pancreas.
Thickening of the right or left anterior pararenal fascia
Severe Acute pancreatitis
Main determinant of clinical outcome is the degree of systemic organ disturbance, particularly during the early hours and days after admission to hospital
More than half of all deaths in AP occur within the first 2 weeks of illness and are usually a consequence of multiple organ failure
The revised Atlanta Classification 3 grades of severity of pancreatitis:
Mild AP—characterized by the absence of organ failure or local complications
Moderately severe AP—defined by...................read on
