What's the most likely diagnosis?

• 47 year old with abdominal pain

1. Pancreatic carcinoma
2. Annular pancreas
3. Renal vein thrombosis
4. Lymphoma
5. Colitis

Additional Image-Coronal CT image of the abdomen

 

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Coronal CT images of the abdomen

 

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Answer:

 

2. Annular pancreas

 

 

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Annular Pancreas

General Considerations

• Rare, congenital anomaly that may not become apparent until adult life
• Pancreas completely (or sometimes incompletely) encircles 2^nd portion of duodenum occasionally obstructing more proximal duodenum
• More commonly affects males
• Pancreas develops from two analogues
  • Larger is dorsal bud which forms body and tail of gland
  • Ventral bud is smaller and forms head of gland as well as parts of the hepatic duct and gallbladder
  • Annular pancreas is believed to develop as a result of abnormalities in migration of the ventral bud such that the two buds join to encircle the duodenum
• Pancreatic duct from the annular portion may drain into the main pancreatic duct or directly into the duodenum

 

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