annular pancreas
Introduction
Introduction to the annular pancreas The annular pancreas (annluarpancreas) is a congenital developmental malformation in which the patient has a band of pancreatic tissue. Partial or complete wrap around the first or second segment of the duodenum, causing the lumen of the intestine to narrow. The annular pancreas is one of the causes of congenital duodenal obstruction in children. It is the abnormal development of pancreatic tissue into a ring or a clamp around the duodenal descending part. When the annular pancreas causes compression on the intestine, it causes twelve. Refers to complete or incomplete obstruction of the intestine. There are many etiology of the ring-shaped pancreas. The ring-shaped pancreas is one of the causes of congenital duodenal obstruction in children. It is the abnormal development of pancreatic tissue into a ring or a clamp around the duodenal descending, when the annular pancreas When the intestine is compressed, it causes complete or incomplete obstruction of the duodenum. For an annular pancreas without symptoms or symptoms, surgery is not necessary. If it has caused 12 guides to intestinal stenosis or obstruction, surgery must be performed. basic knowledge The proportion of illness: 0.02% Susceptible people: no specific population Mode of infection: non-infectious Complications: congenital heart disease, peptic ulcer, acute pancreatitis
Cause
Annular pancreatic cause
There are many etiology of the ring-shaped pancreas. The ring-shaped pancreas is one of the causes of congenital duodenal obstruction in children. It is the abnormal development of pancreatic tissue into a ring or a clamp around the duodenal descending, when the annular pancreas When the intestine is compressed, it causes complete or incomplete obstruction of the duodenum. When there is a developmental disorder, or if some of the ventral pancreatic adduct is attached to the intestine, it will become an ectopic pancreas; or the ventral pancreatic protuberance will not rotate with the duodenum to the left and the dorsal pancreatic protuberance In combination, a band of pancreatic tissue surrounds the duodenum, partially or completely surrounding the first or second segment of the duodenum, narrowing the lumen of the intestine, ie into a ring-shaped pancreas.
Prevention
Annular pancreas prevention
Mothers check during pregnancy to reduce the birth of such children.
Complication
Annular pancreatic complications Complications congenital heart disease peptic ulcer acute pancreatitis
Tongue-like dementia, esophageal atresia, esophageal tracheal fistula, Meckel's diverticulum, congenital heart disease, deformed foot, peptic ulcer, acute pancreatitis, biliary obstruction, etc.
Symptom
Annular pancreatic symptoms common symptoms biliary obstruction nausea and vomiting abdominal pain
Clinically, the annular pancreas is often divided into neonatal and adult types, and its clinical manifestations are closely related to the degree of compression of the duodenum and other pathological changes.
(1) Newborns are more common within 1 week after birth, and more than 2 weeks are rare. Mainly manifested as acute complete duodenal intestinal obstruction. Sick vomiting occurs in sick children, and vomit contains bile. Due to frequent vomiting, dehydration, electrolyte imbalance, acid-base balance disorders, and malnutrition can continue. In the case of incomplete 12-finger obstruction, it is characterized by intermittent abdominal pain and vomiting, which may be accompanied by upper abdominal fullness discomfort and increased after eating. The above symptoms can be repeated. In addition, the annular pancreas is often accompanied by other congenital diseases, such as tongue-like dementia, esophageal atresia, esophageal tracheal fistula, Meckel's diverticulum, congenital heart disease, deformed foot and so on.
(B) adult type is more common in 20 to 40 years old, more manifested as symptoms of duodenal chronic incomplete obstruction, and the sooner the symptoms appear, the more severe the performance of duodenal obstruction. The patient mainly showed repeated epigastric pain and vomiting, which was a paroxysmal attack. The abdominal pain increased after eating, and it was relieved after vomiting. The vomit was gastric duodenal juice containing bile. In addition to duodenal obstruction, patients can also have other pathological changes and cause corresponding clinical symptoms:
Peptic ulcer
Patients with annular pancreas complicated by stomach and duodenal ulcer can reach 30-40%, of which duodenal ulcer is more common. The cause of ulceration may be related to the compression of the annular pancreas, the long-term retention of gastric juice, and the high acidity of the stomach and duodenal contents.
2. Acute pancreatitis
Patients with annular pancreas complicated with pancreatitis account for 15-30%, which may be related to pancreatic ductal system abnormalities, pancreatic juice stasis or bile reflux to the pancreatic duct and cause disease. Pancreatitis can be limited to the part of the annular pancreas or to the entire pancreas. Edema of acute pancreatitis or fibrous scarring of chronic pancreatitis can also aggravate duodenal obstruction.
3. Biliary obstruction
It is rare in clinical practice. Because the annular pancreas is located in the abdomen of the ampulla, the annular pancreas causes the second segment of the duodenum to be obviously narrow and compresses the common bile duct and pancreatitis, etc., it can cause obstruction of the lower common bile duct. jaundice. Patients with long-term illness can also have secondary biliary stones.
Examine
Annular pancreas
Laboratory inspection
Meconium examination: The middle part of meconium is stained and microscopically examined. If squamous epithelial cells or lanugo can be found in the amniotic fluid, it can be inferred that the intestinal tube is unobstructed for a period of time during the fetus. If there is a ring-shaped pancreas and causes complete obstruction, such cells are not found in meconium.
Other auxiliary inspection
1. Abdominal plain film: mainly manifested as duodenal obstruction. In the supine position, the stomach and the duodenum were expanded and flattened, and a so-called double bubble sign appeared. Because the stomach and duodenum ampulla often have a large number of fasting stagnant fluids, it can be seen in the standing position that the stomach and the duodenum have a liquid level. Sometimes the upper and lower intestines of the duodenal stenosis area are flattened, thereby developing the stenosis area.
2. Gastrointestinal barium angiography: manifested as gastric dilatation, sagging, a large number of fasting retentate, the emptying time prolonged duodenal ampullary symmetry enlargement, elongation, the lower edge of the smooth round. Duodenal descending, occasionally a narrow or marginal stenosis in the first or third segment of the cupping network. The stenosis of the stenosis is rare and becomes eccentric and centripetal. Creeping and the presence of ulcers.
3. ERCP: Microscopic angiography can develop the annular pancreatic duct, which is very helpful for diagnosis. Duodenal stenosis caused by the annular pancreas is often in the proximal side of the main nipple. If the endoscope cannot pass through the stenosis, the angiography may not be performed. Sometimes the stenosis of the common bile duct appears at the end of the common bile duct due to the annular pancreas.
4.CT: After the contrast agent is taken, the duodenum is filled. It can be seen that the pancreatic tissue surrounding the duodenum is continuous with the pancreatic head. Usually, the annular pancreatic tissue is thin, and the annular pancreas is not easy to be directly developed. Indirect signs such as enlargement of the head of the pancreas and hypertrophy and stenosis of the descending duodenum are also helpful for diagnosis.
5. Magnetic Resonance (MRI) and Magnetic Resonance Cholangiopancreatography (MRCP): MRI can be seen as a tissue structure that is consistent with the pancreatic head and has the same signal intensity as the pancreas descending segment and the pancreas, which can be confirmed as pancreatic tissue. MRCP can show the annular pancreatic duct through the principle of water imaging. MRCP is painless and non-invasive for patients with non-invasive radiation. It is simple and convenient.
6. Endoscopy: usually the endoscopic mucosa is normal for the diagnosis; in the more severe cases, the duodenal descending part shows a circular stenosis. Duodenal ulcer can be combined at the same time.
Diagnosis
Diagnosis of annular pancreas
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Congenital duodenal atresia
Occasionally seen in the newborn, the lesion is located in the duodenal descending segment, frequent vomiting after birth, vomiting may contain bile, sputum can not pass through the gastrointestinal angiography, there is no gas in the lower bowel. During the operation, there was no pancreatic tissue environment in the descending duodenum.
2. Congenital pyloric hypertrophy
More nausea and vomiting occur several weeks after birth, vomit does not contain bile, upper abdomen is more bulging, there may be gastric peristaltic waves, 95 ~ 100% of the sick children in the right upper quadrant can be licked and olive-shaped mass. Gastrointestinal barium angiography showed gastric dilatation, pyloric tube became thinner and longer, and gastric emptying time was prolonged.
Superior mesenteric artery compression syndrome
This disease refers to the third or fourth segment of the duodenum caused by compression of the superior mesenteric artery, mainly manifested as upper abdominal fullness discomfort, intermittent vomiting, bile in vomit, gastrointestinal sputum angiography See the duodenum with significant blockage and dilation, and the expectorant was blocked in the third or fourth segment of the duodenum.
4. Pancreatic head or abdomen tumor
Patients with annular pancreas with jaundice, especially the elderly, should be differentiated from pancreatic head or duodenal papillary tumors. In the latter gastrointestinal angiography, the duodenal ring was enlarged, the inner edge of the descending part was compressed and deformed, the mucosal folds were destroyed, and there were filling defects, inverted "3" signs, bilateral signs, and the like. In addition, it should be differentiated from congenital choledochal atresia, duodenal tuberculosis, low duodenal ulcer and other diseases.
