Pancreas annulare is a malformation of the pancreas (medical term pancreas). The condition is characterized by the incomplete fusion of the anterior and posterior parts of the pancreas. Pancreas annulare is a very rare disease.
What is annular pancreas?
In annular pancreas disease, the pancreas forms a ring around the duodenum. A special part of the pancreatic system includes the duodenum adjacent at the upper end. This results in an incorrect organ position of the duodenum. Depending on the severity of the compression, there can be significant obstacles in the passage of the pancreas. See gradinmath for What is L5 Syndrome.
Sometimes the annular pancreas is not regarded as a malformation but, depending on the extent, as a normal variant. Depending on the extent of the resulting obstruction, the malformation can already appear in the womb or in the affected newborn. In addition, annular pancreas may not appear until the third or fourth decade of life, or may remain completely asymptomatic.
Causes
The causes of the disease pancreas annulare lie in malformations during the development of the embryo in the womb. A specific part of the pancreas emerges from the duodenum. Due to the different growth rates when the duodenum rotates, the pancreatic duct merges with a special part of the bile ducts (medical term ductus choledochus).
In the further course, the production of hormones begins, whereby the glandular part initially remains without function during the fetal period. In medical research, it is assumed that the hormone insulin plays an important role in growth regulation. This is where the formation of the annular pancreas begins. As part of the formation of the anterior pancreatic bud, two lobes may form with an anterior orientation.
With additional advancement towards the back and fixation of the posterior part, a ring may form around a specific part of the duodenum. As a result, its lumen can be narrowed and the annular pancreas is formed.
Symptoms, Ailments & Signs
Various symptoms can occur in the context of annular pancreas, which depend on the extent of the disease and its severity. It can happen that annular pancreas disease is completely asymptomatic. In this case, there are no symptoms whatsoever, with the result that the people affected are not aware of the disease, so that it cannot be diagnosed and treated.
In the event that particularly strong pressure is exerted on the duodenum as part of the annular pancreas, the most common symptom of the disease is vomiting after eating. In this context, bilious vomiting can also occur. In general, asymptomatic forms of annular pancreas can become symptomatic over the course of life. As a result, in some cases, the annular pancreas is not discovered until adulthood.
Diagnosis & course of disease
Various methods of examination are available to diagnose annular pancreas. Using prenatal diagnostics, the double-bubble phenomenon can provide an important indication of the presence of annular pancreas.
In the event of clinical suspicion, abdominal sonography and a blank abdominal radiograph are usually performed. A differential diagnosis can also be carried out with the help of sonography. This is particularly relevant given that the pancreas can exhibit annular symptoms similar to those of other, sometimes more serious, diseases. Within the framework of this differentiation, hypertrophic pyloric stenosis and duodenal atresia must be ruled out in the first place.
Functional images are taken, and if there is annular pancreas, the so-called double-bubble phenomenon can also be seen in the plain abdominal image. In order to distinguish it from functionally relevant stenoses, the gastrointestinal passage can be examined with special water-soluble contrast media. Other possibilities for diagnosing pancreas annulare consist in carrying out special computed tomography.
Complications
This disease can lead to a wide variety of complications and symptoms. In some cases, however, the disease progresses completely without symptoms, so that sometimes no treatment is necessary. However, the disease can cause problems when eating.
Patients often suffer from nausea and vomiting. In many cases, it is not possible to correctly diagnose where these symptoms come from, so that direct treatment is not possible in the first place. The permanent vomiting can lead to severe mental health problems and depression and thereby significantly reduce the quality of life of those affected. Children can also suffer from developmental disorders if the disease is not treated properly.
As a rule, the malformation of the annular pancreas can be removed relatively easily with the help of a surgical procedure. Complications usually do not arise. However, scars or fistulas can still occur. The patient may need treatment again at a later point in time. The life expectancy of the affected person is not affected if the treatment is successful.
When should you go to the doctor?
A large number of patients with annular pancreas do not experience any symptoms throughout their lives. The malformation therefore often goes unnoticed and is not diagnosed. A doctor’s visit is not necessary. If there are no impairments, no inspection visit is required. Newborns with abnormal eating habits must be examined by a doctor. If breast milk or baby food is vomited immediately, a doctor must be consulted.
There is a need for action if you lose weight, become apathetic or have slack muscles. If there is no body tension, this is to be regarded as a warning. Normally, in the first few days after the birth, care is provided by medically trained staff. Tips and hints are given for the correct handling of the newborn. If irregularities are found, the nursing staff or nurses usually take over the organization of further steps. They ask a doctor for help and a thorough examination of the infant is initiated.
If discoloration is observed in the vomit, this information should be passed on to the treating physician. If the irregularities become apparent in the further development and growth process of the child, a doctor’s visit is also necessary. Underweight, deficiency symptoms, an inner weakness and apathy must be presented to a doctor. A feeling of pressure inside the body is another sign of a health problem.
Treatment & Therapy
Only a small selection of therapeutic methods is available for the treatment of annular pancreas. In the event that symptomatic forms of the disease panreas annulare are present, the affected patients are treated surgically. As part of the surgical procedure, a bypass is placed in the affected stenosed bowel section. The operation usually takes place under general anesthesia.
Another therapeutic measure is to split the node of the pancreas. However, this method is outdated as it entails various risks. These include, for example, fistula formation, duct injuries and scar shrinkage, which can result in renewed compression.
Outlook & Forecast
The prognosis of the annular pancreas is to be evaluated according to the individual characteristics of the health disorder. Basically, it is a congenital disease, the intensity of which is documented differently in each person affected and the prospects are favorable. There are a large number of patients who are symptom-free for life. Nevertheless, they should be examined by a specialist at regular intervals so that any changes can be reacted to immediately.
In most cases, surgical intervention is recommended. The aim of this is to achieve a lifelong freedom from symptoms. If the operation proceeds without further complications, the patient is usually released from treatment after a few weeks as recovered. It is also possible for the course of the disease to be determined by long-term medication. This depends on the health condition of the person concerned.
Other diseases can develop as a result of the symptoms. In the affected patients, the risk of an additional mental disorder is increased. The reason for this is the emotional burden of the disease and its symptoms. It can severely limit the quality of life. A recurrence of the symptoms after an operation is not to be expected. Nevertheless, secondary diseases can occur if everything does not go optimally during the treatment. In the event of unwanted scarring, it should be checked whether the use of further therapies is indicated.
Prevention
In most cases, annular pancreas disease develops in the embryo. Because of this, no effective methods of preventing the disease exist. It is all the more relevant to consult a doctor at the first signs and symptoms of annular pancreas and to have further diagnostic examinations initiated. If the disease appears in childhood, an immediate medical examination is required.
If annular pancreas is asymptomatic and symptoms only develop in adulthood, these should also be clarified by differential diagnosis. In the event of a diagnosis of annular pancreas, the attending physician will give the affected patient individual advice, for example regarding the choice of food, in order to have a positive influence on the further course of the disease and to prevent complications.
Aftercare
In most cases, those affected with pancreas annulare have only limited and only a few follow-up measures available. For this reason, the person affected by this disease should ideally consult a doctor as soon as the first symptoms and signs appear, so that complications or other complaints do not arise for the person affected in the further course.
The sooner a doctor is consulted, the better the further course of the disease, so that a doctor should be contacted as soon as the first signs and symptoms of the disease appear. Most of those affected require surgical intervention. After such a procedure, the patient should rest and rest his body, observing strict bed rest and avoiding stressful activities.
In general, regular check-ups by a doctor are also very important after the procedure in order to identify and treat further damage at an early stage. Further follow-up measures are not available to those affected in the case of annular pancreas. In most cases, this disease does not reduce the life expectancy of the affected person.
You can do that yourself
Since the annular pancreas can be very individual, the symptoms of the affected patients are also very different. They may not have any problems, while others only need surgery to help.
If vomiting is one of the symptoms, it is important for the patient to eat particularly conscientiously in order to avoid deficiencies. This is especially true for children whose development could otherwise be disrupted. Several small meals a day are recommended, which should be easy to digest, but at the same time rich in vitamins, minerals and fiber. A conscious diet not only has a positive influence on the symptoms, but can also compensate for any existing tendency to depression. Because constant nausea and vomiting trigger feelings of helplessness and powerlessness in some of those affected.
Patients are also advised to attend psychotherapeutic sessions. But various relaxation techniques also help to live with this rare disease. This includes gentle sports such as yoga, qigong and tai chi. Reiki, music therapies or EFT tapping therapy have also proven to be relieving. Jacobson’s progressive muscle relaxation, which is even taught in adult education centers, is easy to learn and very effective. Meditation and breathing exercises are also good ways to reduce stress caused by illness. Sport, especially outdoor exercise, also ensures balance.