Karnataka PGET Surgery MCQ Answer 18

The correct answer is D


Annular pancreas is the most common congenital malformation of the pancreas in association with duodenal atresia. Embryologically the ring formation (annulus) originates from the ventral pancreas primordium (Lecco's theory). The pancreatic duct of the annular tissue passed from the anterior portion to the lateral and posterior portion finally joining with the main pancreatic duct.

Two types of annular pancreas are recognized:
1) Extramural - causing high gastrointestinal obstruction; vomiting is the most common presenting symptom
2) Intramural - producing duodenal ulceration.

Presentation at birth is affected by the degree of duodenal obstruction and coexistent anomalies. Polyhydramnios usually accompanies complete high intestinal obstruction in annular pancreas. Associated anomalies can range from malrotation, intrinsic duodenal obstruction, Down syndrome and duodenal bands. ERCP is the most important procedure to find the characteristic features and establish the therapeutic strategy in cases of annular pancreas. Division of annular pancreas is not recommended because risk of damage to major duct.

Therefore, all children with this abnormality are generally treated with a bypass procedure, preferably a duodeno-duodenostomy. Long-term complications may include cholestatic jaundice, upper gastrointestinal motility disorder, failure to thrive, chronic diarrhea and chronic relapsing pancreatitis due to an incomplete divisum anomaly.

Category: Karnataka PGET 2007 MCQs