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January 27, 1969

Annular Pancreas— A Case Report

Author Affiliations

USN US Naval Hospital Camp Pendleton, Calif

JAMA. 1969;207(4):756. doi:10.1001/jama.1969.03150170082023

To the Editor:—  A 21-year-old man entered the hospital because abdominal pain, which had been present intermittently for two weeks, was located in the epigastrium, and usually occurred after meals. There was accompanying nausea and mild vomiting on two occasions. There had been no weight loss or melena.Two years previously an uppergastrointestinal tract x-ray series reportedly had demonstrated an active duodenal ulcer. The patient responded promptly to conservative ulcer therapy.Physical examination, routine laboratory and chest x-ray studies revealed nothing abnormal. An uppergastrointestinal tract x-ray series showed partial obstruction of the second portion of the duodenum with dilatation of the proximal part (Fig 1). An ulcer crater was not identified.At exploratory laparotomy an annular pancreas was identified which completely encircled the second portion of the duodenum (Fig 2). A side-to-side duodenoduodenostomy was performed. There was no evidence of duodenal ulcer. Two months postoperatively the patient was asymptomatic. Postoperative