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Case of the Week 310

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


SpoilerAlert! - enlarged version will have arrows



2. Annular pancreas



More (Click Discussion Tab)

Annular Pancreas

General Considerations

  • Rare, congenital anomaly that may not become apparent until adult life
  • Pancreas completely (or sometimes incompletely) encircles 2nd 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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