We have received a young man with a long history of
vomiting. The vomiting was mostly post-prandial, about 30 minutes after meals.
He had been followed up in another facility for the last 1
year, with no improvement at all. He was not responding to treatment with potent
prokynetics.
The patient was wasted.
Gastroscopy was negative up to the second portion of
duodenum which looked stenotic, although the mucosal pattern was normal.
Thinking of an external duodenal compression causing gastric
outlet obstruction, we have performed an ultrasound, which was unremarkable.
Therefore we have decided to do a CT scan of the abdomen: the latter imaging procedure diagnosed a
stricture of the second portion of duodenum possibly from congenital bands or
annular pancreas.
In order to help the patient and to reach a definitive
diagnosis we have counseled him on explorative laparatomy.
The operation has been performed today and has confirmed the
presence of an annular pancreas causing the duodenal stricture. There were no
congenital bands.
When an annular pancreas obstructs the duodenum, a direct
attack by division of the ring is hazardous since it divides the ring duct, a
condition frequently followed by a pancreatic fistula. The indirect attack of
bypassing the lesion is described as the best approach in the textbooks we have
consulted. Therefore we have decided to do a gastro-jejunal anastomosis, which
will allow the patient to feed without problems.
Annular pancreas is a congenital condition often associated
with other malformations. We hope that is not the case for our patient, and we
wish him quick recovery.
We express heartfelt gratitude to Dr Max who has guided us
and encouraged us in the operation. It was the first case in Chaaria.
Source:
Anson, Mc Vay. Surgical Anatomy. Volume 1, pag 631-632. Saunders
Bro Dr Beppe
Gaido
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