Imaging pearls of the annular pancreas on antenatal scan and its diagnostic dilemma: A case report

Authors

  • Pradeep Kumar Roul Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh
  • Ashish Kaushik Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh
  • Manish Kumar Gupta Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh
  • Poonam Sherwani Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh

DOI:

https://doi.org/10.47338/jns.v9.669

Keywords:

Annular pancreas, Duodenal obstruction, Double bubble sign, Hyperechogenic band

Abstract

Background: Annular pancreas is an uncommon cause of duodenal obstruction and rarely causes complete duodenal obstruction. Due to its rarity of identification in the antenatal period and overlapping imaging features with other causes of duodenal obstruction; it is often misdiagnosed.

Case presentation: A 33-year-old primigravida came for routine antenatal ultrasonography at 28 weeks and 4 days of gestational age. On antenatal ultrasonography, dilated duodenum and stomach were seen giving a double bubble sign and a hyperechoic band surrounding the duodenum. Associated polyhydramnios was also present. Fetal MRI was also done. Postpartum ultrasonography demonstrated pancreatic tissue surrounding the duodenum. The upper gastrointestinal contrast study showed a non-passage of contrast beyond the second part of the duodenum. Due to symptoms of obstruction, the neonate was operated on, and the underlying cause was found to be the annular pancreas.

Conclusion: Diagnosis of duodenal obstruction due to the annular pancreas is very important in the antenatal period to plan for appropriate therapeutic interventions after birth. A double bubble sign is seen due to various etiologies however the presence of a hyperechoic band in the antenatal ultrasound may point to the diagnosis of the annular pancreas.

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Author Biographies

Pradeep Kumar Roul, Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh

Junior Resident

Ashish Kaushik, Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh

Senior Resident (MD radiodiagnosis)

Manish Kumar Gupta, Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh

Assistant Professor (Pediatric Surgery)

Poonam Sherwani, Department of Radiodiagnosis, All India Institute of Medical Sciences, Rishikesh

Associate Professor

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Published

2020-10-17

How to Cite

1.
Roul PK, Kaushik A, Gupta MK, Sherwani P. Imaging pearls of the annular pancreas on antenatal scan and its diagnostic dilemma: A case report. J Neonatal Surg [Internet]. 2020Oct.17 [cited 2020Oct.27];9:27. Available from: https://www.jneonatalsurg.com/ojs/index.php/jns/article/view/669