Pancreatic Pathology Online

Pathology of Annular Pancreas

Dr Sampurna Roy MD               July 2016


Annular pancreas is a fairly uncommon condition in which the head of the gland surrounds the second portion of the duodenum with risk of obstruction.

Encirclement may be complete or incomplete.

Annular pancreas may be associated with duodenal atresia, an anomaly that requires surgery soon after birth.

Such infants infrequently have other congenital anomalies, including trisomy 21 (Down syndrome).

Many patients with annular pancreas do not require surgery in early life but develop symptoms at 60 or 70 years of age.

More commonly, the diagnosis is made incidental to radiologic studies for a duodenal ulcer.

This anomaly is probably due to a failure of the ventral anlage to migrate behind the duodenum.

Since this migration is due to increased focal growth of the duodenal wall, the annular pancreas reflects impaired development of the duodenum.

Failure of fusion of the rudiments of the pancreas leads to two separate glands, each with its separate duct draining into the duodenum.

Persistence of two separate ducts from dorsal and ventral pancreas predisposes to recurrent pancreatitis.


Further reading:

Annular pancreas: a review of its molecular embryology, genetic basis and clinical considerations.

Portal annular pancreas: a systematic review of a clinical challenge.

Annular pancreas: A potentially overlooked congenital pancreatic anomaly.

Evidence for annular pancreas as an associated anomaly in the VATER/VACTERL association and investigation of the gene encoding pancreas specific transcription factor 1A as a candidate gene.

Annular pancreas concurrent with pancreaticobiliary maljunction presented with symptoms until adult age: case report with comparative data on pediatric cases.

Annular pancreas in adults: a report of two cases and review of literature.

Annular pancreas in identical twin newborns.

Annular pancreas combined with distal stenosis. A report of four cases and review of the literature.




Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)






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