Annular Pancreas: Dramatic Differences Between Children and Adults - 01/11/17

Doi : 10.1016/j.jamcollsurg.2007.12.009

Nicholas J. Zyromski, MD ^a,^⁎, John A. Sandoval, MD ^a, Henry A. Pitt, MD, FACS ^a, Alan P. Ladd, MD, FACS ^a, Evan L. Fogel, MD ^b, Wissam E. Mattar, MD ^b, Kumar Sandrasegaran, MD ^c, David W. Amrhein, MD ^a, Fredrick J. Rescorla, MD, FACS ^a, Thomas J. Howard, MD, FACS ^a, Keith D. Lillemoe, MD, FACS ^a, Jay L. Grosfeld, MD, FACS ^a
^a Department of Surgery, Indiana University School of Medicine, Indianapolis, IN
^b Department of Medicine, Indiana University School of Medicine, Indianapolis, IN
^c Department of Radiology, Indiana University School of Medicine, Indianapolis, IN.

Correspondence address: Nicholas J Zyromski, MD, Department of Surgery, Indiana University School of Medicine, 1001 W 10 St, OPE 334, Indianapolis, IN 46202.

Résumé

Background

Annular pancreas is rare; only 737 cases have been reported in the English literature. In addition, no large analysis has compared children and adults. Recently, prenatal diagnosis and advances in imaging have led to increased experience with this condition.

Study Design

Data from 103 patients (48 children, 55 adults) with annular pancreas, managed from 1992 to 2006, were reviewed. Patients with isolated duodenal atresia, stenosis, or webs were excluded.

Results

Median ages at diagnosis were 1 day in children and 47 years in adults. Annular pancreas was more common in girls and women (children, 58%; adults, 69%). Congenital anomalies were more frequent (p < 0.01) in children (71%) than in adults (16%); Down syndrome, cardiac, and intestinal anomalies were most common. Prenatal diagnosis was suspected in 56% of infants, and adults presented with pain (75%), vomiting (24%), pancreatitis (22%), or abnormal liver tests (11%). All children were managed with duodenal bypass. Children were more likely (p < 0.01) to require surgery for associated anomalies. In contrast, adults had fewer duodenal bypass procedures (24%) but more often required endoscopic pancreatobiliary procedures (67%), cholecystectomy (56%), and other pancreatobiliary surgery (20%; p < 0.01). Adults more commonly (p < 0.01) had pancreas divisum (29%) and pancreatobiliary neoplasia (11%). Five children (6%) with multiple anomalies died; all adults survived their operations. Late deaths occurred in 2 children (4%) with multiple anomalies and 3 adults (5%) with pancreatobiliary cancer.

Conclusions

Annular pancreas is associated with a spectrum of disease that differs in children and adults. Congenital anomalies are more common in children with annular pancreas; complex pancreatobiliary disorders and malignancy are more frequent in adults.

Le texte complet de cet article est disponible en PDF.