Annular pancreas associated with nutcracker syndrome: A case report

Year 2013, , 681 - 684, 01.12.2013

Ayşe Sağıroğlu Afra Yıldırım Niyazi Acer Turgut Tursem Tokmak Emel Günay Mevlüt Başkol

https://doi.org/10.5798/diclemedj.0921.2013.04.0359

Abstract

The pancreas usually develops from the fusion of the dorsal and ventral pancreatic buds between the first 4-8 weeks of embryonic life. Annular pancreas consists of a ring of pancreatic tissue, which partially or completely surrounds the descending portion of the duodenum. Annular pancreas is an uncommon congenital anomaly. The etiology of this anomaly is still unknown. It has been associated with other congenital anomalies and various clinical symptoms. The nutcracker phenomenon is defined as compression of the left renal vein between the aorta and superior mesenteric artery. We report the case of a 54-year-old patient who presented with a 15-day history of nausea and vomiting associated with weight loss. On magnetic resonance cholangiopancreatography (MRCP) and computer tomography (CT) examination, an annular pancreas and nutcracker syndrome were diagnosed, respectively. In this study, we founded that the radiologic and clinical findings of associated annular pancreas with nutcracker syndrome may be of clinical importance for surgical procedures.

Keywords

Annular pancreas, congenital anomaly, nutcracker phenomenon, MRCP, CT

Nutcracker sendromu ile birlikte anüler pancreas: Olgu sunumu

Abstract

Pancreas genellikle embriyolojik hayatın ilk 4-8 haftaları arasında dorsal ve ventral pankreas tomurcuklarının birleşmesinden gelişir. Anüler pancreas, pancreas dokusunun pars descendens duodeni\'yi kısmi ya da tamamen halka şeklinde sarmasıyla oluşur. Anüler pancreas yaygın olmayan bir konjenital anomalidir. Bu anomalinin etyolojisi hala bilinmemektedir. Bu anomali, diğer konjenital anomaliler ve çeşitli klinik semptomlarla birliktelik gösterebilmektedir. Nutcracker fenomeni, v.renalis sinistra\'nın aorta abdominalis ile a.mesenterica superior arasında sıkışması olarak tanımlanır. 15 gündür bulantı ve kusma ile birlikte kilo kaybı olan 54 yaşında bir hastanın olgusunu bildirdik. MRKP (Manyetik rezonans kolanjiopankreatografi) ve BT (bilgisayarlı tomografi) incelemelerinde anüler pancreas ve nutcracker sendromu tanısı konuldu. Biz bu çalışmada, radyolojik ve klinik olarak anüler pankreas ile nutcracker sendromunun birlikteliğininin cerrahi girişimler için klinik açıdan önemli olabileceğini gösterdik.

Keywords

Anüler pancreas, konjenital anomali, nutcracker fenomeni, MRKP, BT

References

• Whittingham-Jones PM, Clayton G, Thompson HH. Annular pancreas - a rare cause of gastric obstruction in an 82-year- old patient. Ann R Coll Surg Engl 2005;87:W13-5.
• Brönnimann E, Potthast S, Vlajnic T, et al. Annular pancreas associated with duodenal carcinoma. World J Gastroenterol 2010;16:3206-3210.
• Singh P, Sandhu P, Saggar K, Ahluwalia A. Annular pancre- as. Indian J Gastroenterol 2010;29:250.
• Jarry J, Wagner T, Rault A, et al. Annular Pancreas: A Rare Cause of Acute Pancreatitis. JOP 2011;12:155-157.
• Ulusan S, Koc Z. Left Inferior Vena Cava Associated with Nutcracker Phenomenon. Fırat Tıp Dergisi 2007;12:151- 153.
• Paraskevas G, Papaziogas B, Lazaridis C, et al. Annular pan- creas in adults: embryological development, morphology and clinical significance. Surg Radiol Anat 2001;23:437- 442.
• Cunha JEM, Lima MS, Jukemura J, et al. Unusual Clinical Presentation of Annular Pancreas in the Adult. Pancreatol- ogy 2005;5:81-85.
• Baldwin WA. A specimen of annular pancreas. Anat Rec 1910;4:299-304.
• Lecco TM. Zur Morphologie des Pankreas annulare. Sit- zungb Akad Wissensch 1910;119:391-406.
• Sandrasegaran K, Patel A, Fogel EL, et al. Annular Pan- creas in Adults. AJR 2009;193:455.
• Hollander L, Marie A. Pankreas Annulare. In: von Allgower M, Harder F, Hollender F, Peiper J. (eds) Chirugische Gas- troenterologie. Berlin: Springer 1981;1058-1060.
• Reinhart RD, Brown JJ, Foglia RP, Aliperti G. MR imag- ing of annular pancreas. Abdom Imaging 1994;19:301-303.
• Desai MB, Mitchell DG, Munoz SJ. Asymptomatic annular pancreas: detection by magnetic resonance imaging. Magn Reson Imaging 1994;12:683-685.
• Hidaka T, Hirohashi S, Uchida H, et al. Annular pancreas diagnosed by single-shot MR cholangiopancreatography. Magn Reson Imaging 1998;16:441-444.
• Zyromski NJ, Sandoval JA, Pitt HA, et al. Annular pan- creas: dramatic differences between children and adults. J Am Coll Surg 2008;206:1019-1027.
• Barsoum MK, Shepherd RFJ, Welch TJ. Patient with both Wilkie syndrome and nutcracker syndrome. Vascular Medi- cine 2008;13:247-250.
• Kurklinsky AK, Rooke TW. Nutcracker Phenomenon and Nutcracker Syndrome. Mayo Clin Proc 2010;85:552-559.