title: Annular pancreas with obstructive jaundice: beware of underlying neoplasm.
abstract: BACKGROUND
  Annular pancreas is a rare congenital abnormality, and in adult patients it presents with clinical features that differ from those seen in newborns. Features in the adult patient include peptic ulceration, duodenal obstruction, acute pancreatitis, and obstructive jaundice. Treatment strategies for annular pancreas with obstructive jaundice remain controversial.
  
  
  OBJECTIVE
  To present three cases involving adult patients with annular pancreas and obstructive jaundice, due to carcinoma of the ampulla of Vater in two patients and chronic pancreatitis in the third.
  
  
  RESULTS
  Pancreaticoduodenectomy was performed on all patients, and the postoperative courses were uneventful.
  
  
  CONCLUSIONS
  Our experience suggests that for adult patients with annular pancreas presenting with obstructive jaundice, it is necessary to consider the possibility of associated or coexisting periampullary malignancy.
authors.affiliation: Department of Surgery, College of Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
authors.forename: Yan-Shen
authors.initials: YS
authors.lastname: Shan
authors.forename: Edgar D
authors.initials: ED
authors.lastname: Sy
authors.forename: Pin-Wen
authors.initials: PW
authors.lastname: Lin
mesh_terms: D000328:Adult; D014670:Ampulla of Vater; D002277:Carcinoma / Q000150:complications / Q000175:diagnosis*; D001651:Cholestasis, Extrahepatic / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D002908:Chronic Disease; D003138:Common Bile Duct Neoplasms / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000002:abnormalities* / Q000000981:diagnostic imaging; D016577:Pancreaticoduodenectomy; D010195:Pancreatitis / Q000150:complications; D014057:Tomography, X-Ray Computed