Annular pancreas

In embryology, the pancreas annulare is the name for a rare malposition of the pancreas ( pancreas ). This leads to an incomplete fusion of the ventral and dorsal parts of the pancreas. One possible consequence is duodenal stenosis .

Embryonic development of the pancreas

The exocrine part of the pancreas arises from a ventral (about 28th day) and a dorsal budding (about 26th day) of the duodenum. After a physiological rotation of the duodenum caused by different growth rates, a fusion of the excretory duct of the pancreas with the later common bile duct (with variations) and a fusion of both pancreatic structures results . The execution corridor system shows this development later. The endocrine part is formed around the 9th week. This emerges from the epithelium of the pancreatic ducts and further differentiates into the so-called islets of Langerhans . Soon afterwards, hormone production begins, while the exocrine part remains inoperable during the fetal period. It is believed that the hormone insulin produced by the beta cells plays an important role in regulating growth. An indication of this is the more than three times higher percentage of beta cells in the fetus than in adults.

Pathomechanism

If the ventral pancreatic anlage results in the formation of two lobes with an additional further development towards the ventral to the dorsal direction or fixation of the ventral part, a ring is formed around the descending part of the duodenum with the result of a potential narrowing of its lumen . Depending on the extent of the obstacle to passage, this can already become apparent in the womb, as a newborn or only in the 3rd or 4th decade of life, but it can also remain completely symptom-free. The diagnosis is made using sonography , ERCP, and CT . Typical symptoms are (possibly bilious) postprandial vomiting ( after feeding ) and flatulence.

Even before birth in the context of prenatal diagnostics , the “ double-bubble phenomenon ” is an important indicator, a soft marker . In the horizontal x-ray of the abdomen while hanging, the appearance of a second "gastric blister" on the right of the spine is characteristic of a high degree of obstruction of the duodenum due to various causes, including: a. also the annular pancreas. For more see duodenal atresia .

Symptomatic patients can be helped with a side-to-side duodenoduodenostomy or, in extreme cases, a duodenojejunostomy (an anastomosis of the duodenum and the jejunum ). This creates an anastomosis that bypasses the bottleneck. In connection with trisomy 21 , the occurrence of the pancreas annulare is observed frequently.

literature

• Johannes W. Rohen, Elke Lütjen-Drecoll: Functional Embryology . The development of the functional systems of the human organism. 2., revised. and exp. Edition. Schattauer, Stuttgart 2004, ISBN 3-7945-2285-0 , p. 91 .
• Jörg Rüdiger Siewert: Surgery . 8., completely revised. Edition. Springer, Heidelberg 2006, ISBN 3-540-30450-9 , pp. 570, 698, 925-926 .
• Gustav-Adolf von Harnack , Berthold Koletzko (ed.): Child and youth medicine . Springer, Heidelberg 2007, ISBN 978-3-540-48632-9 , p. 451.

Individual evidence

1. ↑ Johannes W. Rohen, Elke Lütjen-Drecoll: Functional Embryology . 2., revised. and exp. Edition. Schattauer, Stuttgart 2004, ISBN 3-7945-2285-0 , p. 91 .
2. ↑ W. Schuster, D. Färber (Ed.): “Children's radiology. Imaging diagnostics. ”Springer 1996, ISBN 3-540-60224-0 .
3. ^ Jörg Rüdiger Siewert: Surgery . 8., completely revised. Edition. Springer, Heidelberg 2006, ISBN 3-540-30450-9 , pp. 925-926 .

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !