Irene Isabel P Lim, MD, Paresh C Shah, MD, FACS. New York University Medical Center
More commonly found in newborns, annular pancreas is associated with abnormal development resulting in a ring of pancreatic tissue around the duodenum. This is a case of a variant of annular pancreas presenting in adulthood. The patient is a forty-year old female with persistent abdominal pain for three months. Previous evaluation was suggestive for a thick-walled paraduodenal mass thought to be a duplication cyst. Her surgical history was significant for exploratory laparotomy for perforated gastric ulcers as an infant. Initially, her pain would resolve after percutaneous aspiration of the cyst and a course of antibiotics. Symptoms recurred, with pain persisting despite analgesics and operative resection of the mass was planned. During laparoscopy, this cystic mass appeared to be contiguous with the stomach as well as a segment of pancreatic tissue that was inflamed. This segment appeared to arise from the ventral pancreatic gland and traverse anteriorly towards the proximal duodenum. Unlike the classic annular pancreas, it did not encircle the duodenum, but instead, ended in a thick-walled cyst that appeared contiguous with the stomach. Intraoperative endoscopy, however, showed no luminal communication between the cyst and the stomach. Preoperative imaging did not show any communication with the main pancreatic duct. The cyst and aberrant pancreatic segment were dissected free from the duodenum and normal pancreas, and transected from the normal pancreatic body with a vascular load stapler. The cyst was incised and turbid fluid was released. Pathology was consistent with a thick-walled cyst between gastric and pancreatic tissue, with an aberrant relationship between the stomach and pancreas. The ectopic annular pancreas and pseudocyst are likely congenital and perhaps, provide a better explanation for the patient’s laparotomy during infancy than perforated gastric ulcers. This is a unique presentation of an aberrant annular pancreas with a pseudocyst in an adult.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86747
Program Number: V013
Presentation Session: Liver/Pancreas Video Session
Presentation Type: Video