Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with symptoms suggestive of duodenal obstruction secondary to annular pancreas. Clinical history significant for postprandial epigastric pain, recurrent bilious vomiting, early satiety, and weight loss. Symptoms are consistent with extrinsic compression of the second portion of the duodenum by a complete pancreatic ring. No history of pancreatitis or peptic ulcer disease noted.
Clinical Examination Findings
Abdominal examination reveals mild epigastric distension with visible peristaltic waves in the upper abdomen. Tenderness noted upon deep palpation of the epigastrium. Bowel sounds are hyperactive. No palpable masses or organomegaly detected. Signs of dehydration present secondary to chronic vomiting.
Treatment Protocol
Surgical bypass is the definitive treatment for symptomatic complete annular pancreas. Recommended procedure: Duodenoduodenostomy or duodenojejunostomy to bypass the obstructed duodenal segment. Preoperative stabilization with intravenous fluids and electrolyte correction is mandatory. Postoperative management includes nasogastric decompression and gradual advancement of enteral nutrition.