Recurrent pancreatitis caused by pancreatobiliary anomalies in children with annular pancreas.
OBJECTIVE
Annular pancreas (AP) is usually associated with duodenal obstruction in neonates. Pancreatitis with AP occurs frequently in adults but is rare in children. This article describes pancreatitis in children with AP and pancreatobiliary anomalies and its surgical treatment.


METHODS
Six children who underwent duodenal bypass for AP subsequently developed recurrent pancreatitis. Three had trisomy 21. Duodenoduodenostomy had been performed in 5 patients and gastrojejunostomy in 1 patient for neonatal duodenal obstruction. We reviewed overall management, imaging, and surgical treatment in these children.


RESULTS
All children subsequently complained of recurrent abdominal pain. Pancreatitis developed in 6 children, and magnetic resonance cholangiopancreatography and endoscopic retrograde cholangiopancreatography (ERCP) revealed associated pancreatobiliary anomalies such as pancreas divisum, pancreatobiliary malunion, choledochocele, and intraluminal duodenal diverticulum. In 5 cases, surgery for recurrent or chronic pancreatitis was performed. The range of follow-up was 11 to 54 months, and all children who underwent surgery had excellent results.


CONCLUSIONS
Children with AP occasionally require reoperation for recurrent pancreatitis because of associate pancreatobiliary anomalies. Magnetic resonance cholangiopancreatography and ERCP provide excellent images of pancreatobiliary anomalies. Intraoperative cholangiopancreatography is also essential for accurate depiction of the ductal structure and selection of the appropriate surgical procedure.
Urushihara
Naoto
N
Department of Pediatric Surgery, Shizuoka Children's Hospital, 860 Urushiyama, Aoi-ku, Shizuoka 420-8660, Japan. naoto.u.1222@cy.tnc.ne.jp
Fukumoto
Koji
K
Fukuzawa
Hiroaki
H
Suzuki
Komei
K
Matsuoka
Takanori
T
Kawashima
Shoko
S
Watanabe
Kentaro
K
Hasegawa
Shiro
S
D001652:Bile Ducts / Q000002:abnormalities*; D002648:Child; D002675:Child, Preschool; D015529:Choledochal Cyst / Q000150:complications / Q000601:surgery; D004380:Duodenal Obstruction / Q000150:complications* / Q000601:surgery; D004385:Duodenostomy; D005260:Female; D006801:Humans; D007223:Infant; D007409:Intestinal Atresia / Q000150:complications / Q000601:surgery; D008297:Male; D010179:Pancreas / Q000002:abnormalities*; D010195:Pancreatitis / Q000209:etiology* / Q000601:surgery; D012008:Recurrence; D012086:Reoperation