title: Annular pancreas concurrent with pancreaticobiliary maljunction presented with symptoms until adult age: case report with comparative data on pediatric cases.
abstract: BACKGROUND
  Annular pancreas (AP) concurrent with pancreaticobiliary maljunction (PBMJ), an unusual coexisted congenital anomaly, often presented symptoms and subjected surgical treatment at the early age of life. We reported the first adult case of concurrent AP with PBMJ presented with symptoms until his twenties, and performed a literature review to analyze the clinicopathological features of such cases comparing with its pediatric counterpart.
  
  
  METHODS
  The main clinical features of this case were abdominal pain and increased levels of plasma amylase as well as liver function test. A complete type of annular pancreas with duodenal stenosis was found, and dilated common bile duct with high confluence of pancreaticobiliary ducts was also observed. Meanwhile, extremely high levels of bile amylase were detected both in common bile duct and gallbladder. The patient received duodenojejunostomy (side-to-side anastomosis) as well as choledochojejunostomy (Roux-en-Y anastomosis), and was discharged in a good condition.
  
  
  CONCLUSIONS
  AP concurrent with PBMJ usually presents as duodenal obstruction in infancy, while manifests as pancreatitis in adulthood. Careful long-term follow-up is required for children with AP considering its association with PBMJ which would induce various intractable pathologic conditions in the biliary tract and pancreas.
authors.forename: Long
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Department of General Surgery, General Hospital of Chengdu Military Command, Chengdu, Sichuan Province, People's Republic of China. tfz3006101@163.com.
authors.forename: Fuzhou
authors.initials: F
authors.lastname: Tian
authors.forename: Tiejun
authors.initials: T
authors.lastname: Zhao
authors.forename: Yong
authors.initials: Y
authors.lastname: Pang
authors.forename: Zhulin
authors.initials: Z
authors.lastname: Luo
authors.forename: Jiandong
authors.initials: J
authors.lastname: Ren
mesh_terms: D000328:Adult; D001652:Bile Ducts / Q000002:abnormalities*; D049448:Cholangiopancreatography, Magnetic Resonance; D002768:Choledochostomy; D004380:Duodenal Obstruction / Q000150:complications / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007409:Intestinal Atresia; D008297:Male; D010179:Pancreas / Q000002:abnormalities* / Q000601:surgery; D010182:Pancreatic Diseases / Q000150:complications / Q000175:diagnosis* / Q000601:surgery; D010183:Pancreatic Ducts / Q000002:abnormalities*; D010195:Pancreatitis / Q000209:etiology; D014057:Tomography, X-Ray Computed