title: Symptomatic adult annular pancreas: report of two cases and a review of the literature.
abstract: BACKGROUND
  Annular pancreas in adults is a rare embryologic abnormality detected after development of complications. Embryology, diagnosis and treatment strategies for symptomatic adult annular pancreas remain controversial. In this paper we reevaluated these problems in view of the technological and theoretical advances.
  
  
  METHODS
  In 2 patients with annular pancreas, one(36-year-old male patient) presenting with duodenal obstruction and duodenal ulcer associated with duodenocolic fistula underwent Billroth II gastrectomy and fistula ectomy and the other(17-year-old male patient) presenting with duodenal obstruction and duodenal ulcer underwent Billroth II gastrectomy. English language literature about annular pancreas etiology, diagnosis and treatment was reviewed.
  
  
  RESULTS
  Both of the patients had uneventfully recovered. Abdominal computed tomography, endoscopic retrograde cholangiopancreatography and magnetic resonance cholangiopancreatography showed typical images of annular pancreas. Duodenal bypass procedure, choledochojejunostomy, endoscopic sphincterotomy or biliary stenting, and pancreatic resection were alternative to treat this sort of anomaly.
  
  
  CONCLUSIONS
  Annular pancreas in adults is a rare congenital abnormality, while newer imaging modalities and an index of suspicion may assist in finding more cases. The management of this congenital anomaly should be individualized according to the associated complications.
authors.affiliation: Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China.
authors.forename: Pei-Fen
authors.initials: PF
authors.lastname: Fu
authors.forename: Ji-Ren
authors.initials: JR
authors.lastname: Yu
authors.forename: Xiao-Sun
authors.initials: XS
authors.lastname: Liu
authors.forename: Qian-Yun
authors.initials: QY
authors.lastname: Shen
authors.forename: Shu-Sen
authors.initials: SS
authors.lastname: Zheng
mesh_terms: D000293:Adolescent; D000328:Adult; D001464:Barium; D004380:Duodenal Obstruction / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D010179:Pancreas / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D011860:Radiography, Abdominal; D014057:Tomography, X-Ray Computed
chemical_list: D001464:Barium