A 65-year-old man was admitted to our hospital in chief complaint for epigastric pain and faeces pale. Laboratory data showed elevation of hepatobiliary enzymes. Abdominal ultrasonography, MRI, PET-CT and endoscopic ultrasonography revealed pancreatic mass located in the pancreatic head. Also, endoscopy showed stenosis of the duodenum and CT showed an annular pancreas.
Pyrolus-preserved pancreoduodenectomy (PpPD) was performed. The histopathological examination showed invasive ductal carcinoma of pancreatic head.
An annular pancreas is a rare congenital anomaly and is classified into neonatal, pediatric, and adult types. In neonatal and pediatric type, severe nausea and vomiting due to duodenal obstruction or stenosis are common at presentation. In adult type, many cases are asymptomatic, and about one-half to two-thirds present with peptic ulcers, gallstone or pancreatitis.
An annular pancreas itself seldom causes obstructive jaundice in adult, so we should consider the coexistence of malignancy in a case of an annular pancreas with obstructive jaundice.
