Annular pancreas

At Annular pancreas it is a malposition of the pancreas (medical name pancreas). The disease is characterized by the fact that the anterior and posterior parts of the pancreas incompletely fuse together. Annular pancreas is a very rare disease.

What is Annular Pancreas?

Various symptoms can occur in the context of pancreas annulare, which depend on the severity of the disease and its severity. It can happen that the pancreas annular disease is completely asymptomatic.
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With the disease Annular pancreas the pancreas constricts the duodenum in a ring. A special part of the pancreatic system comprises the duodenum, which is adjacent to the upper end. This results in an incorrect organ position in the duodenum. Depending on the degree of compression, considerable obstacles can arise in the passage of the pancreas.

Sometimes the annular pancreas is not viewed as a malformation but, depending on its extent, also as a normal variant. Depending on the severity of the passage obstruction, the malformation can already appear in the womb or in the affected newborn. In addition, pancreas annular may not appear until the third or fourth decade of life or remain completely symptom-free.

causes

The causes of the annular pancreas disease are malformations during the development of the embryo in the womb. A certain part of the pancreas emerges from the duodenum. Due to the different growth speeds when the duodenum is rotated, the excretory duct of the pancreas merges with a special part of the biliary tract (medical name Common bile duct).

In the further course, the production of hormones begins, whereby the glandular part initially remains without function during the fetal period. Medical research suggests that the hormone insulin plays an important role in regulating growth. This is where the formation of the annular pancreas begins. As part of the formation of the anterior pancreatic anlage, two lobes facing the front can form.

With an additional further development towards the back and the fixation of the rear part, a ring can form around a special part of the duodenum. This can narrow its lumen and create an annular pancreas.

Symptoms, ailments & signs

Various symptoms can occur in the context of pancreas annulare, which depend on the severity of the disease and its severity. It can happen that the pancreas annular disease is completely asymptomatic. In this case, there are no symptoms whatsoever, which means that people are unaware of the condition and cannot be diagnosed or treated.

In the event that particularly strong pressure is exerted on the duodenum in the context of the annular pancreas, vomiting after ingesting food is the most common symptom of the disease. In this context bilious vomiting can also occur. In general, asymptomatic forms of pancreas annulare can become symptomatic in the course of life. In some cases, this means that the annular pancreas is not discovered until adulthood.

Diagnosis & course of disease

Various examination methods are available for diagnosing pancreas annulare, and the treating physician decides whether to use them depending on the symptoms shown and the severity of the disease. Using prenatal diagnostics, the double-bubble phenomenon can give an important indication of the presence of pancreas annulare.

In the case of clinical suspicion, an ultrasound of the abdomen and a blank abdomen are usually performed. A differential diagnosis can also be performed with the aid of sonography. This is particularly relevant in light of the fact that the pancreas can show annular symptoms that are similar to those of other, sometimes more serious diseases. In the context of this delimitation, hypertrophic pyloric stenosis and duodenal atresia must primarily be excluded.

Functional recordings are made; in addition, if there is anular pancreas, the so-called double-bubble phenomenon can be seen in the empty abdomen. In order to distinguish it from functionally relevant stenoses, the gastrointestinal passage can be examined with special water-soluble contrast media. Other ways of diagnosing pancreas annulare are to carry out special computed tomographies.

Complications

This disease can have very different complications and complaints. In some cases, however, the disease proceeds completely without symptoms, so that sometimes no treatment is necessary. However, the disease can lead to discomfort when ingesting food.

The 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 primarily not possible. Persistent vomiting can lead to severe psychological complaints and depression and significantly reduce the quality of life of those affected. Likewise, children can also suffer from developmental disorders if the disease is not treated properly.

As a rule, the malformation of pancreas annulare can be removed relatively easily with the help of a surgical procedure. There are usually no complications. However, there may still be scars or fistulas. The patient may need to be treated again at a later point in time. The life expectancy of the person affected is not affected by successful treatment.

When should you go to the doctor?

In a large number of patients, pancreas annular does not show any symptoms for life. 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 who develop abnormal food intake must be examined by a doctor. If you vomit the breast milk or baby formula you have been given, you must consult a doctor.

Action is required in the event of weight loss, apathy or slack muscles. If there is no body tension, this should be viewed as a warning. Normally, medically trained staff are looked after in the first few days after delivery. Tips and advice on how to handle the newborn correctly are given. If there are any irregularities, the nurses or nurses will in most cases take over the organization of further steps. A doctor will be asked for help by them and a thorough examination of the infant will be initiated.

If discoloration is observed in the vomit, this information should be passed on to the treating doctor. 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 indifference must be presented to a doctor. A feeling of pressure inside the body is another sign of a health disorder.

Treatment & Therapy

There is only a small selection of therapeutic methods available for treating pancreas annulare. In the event that symptomatic forms of Panreas annulare are present, the affected patients are treated surgically. As part of the surgical procedure, a bypass is placed in the affected stenosed section of the intestine. The operation usually takes place under general anesthesia.

Another therapeutic measure is to split the pancreatic constriction ring. However, this method is out of date as it involves various risks. These include, for example, fistulas, duct injuries and scar shrinkage, which can result in renewed compression.

Outlook & forecast

The prognosis of the annular pancreas is to be assessed according to the individual characteristics of the health disorder. Basically, it is a congenital disease, the intensity of which is documented differently for 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 changes can be taken immediately.

In most cases, a surgical intervention is recommended. The aim of this is to achieve lifelong freedom from symptoms. If the operation proceeds without further complications, the patient is usually discharged from treatment after a few weeks as recovered. A disease course that is determined by long-term medication is also possible. This depends on the health of the person concerned.

Other diseases can develop due to the symptoms. The affected patients have a higher risk of an additional psychological disorder. The reason for this is the emotional burden of the disease and its symptoms. The quality of life can be severely impaired. A relapse of the symptoms is not to be expected after an operation. However, secondary illnesses can occur if not everything went optimally during treatment. In the event of undesirable scarring, it should be checked whether the use of further therapies is indicated.

prevention

In most cases, the annular pancreas develops in the embryo. Because of this, there are no effective methods of preventing the disease. It is all the more relevant to consult a doctor at the first signs and symptoms of pancreas annulare and to have further diagnostic examinations initiated. If the disease already appears in childhood, an immediate medical examination is required.

If the annular pancreas has an asymptomatic course and symptoms only develop in adulthood, these should also be clarified by differential diagnosis. When diagnosing pancreas annulare, the attending physician will give the patient individual advice, for example regarding the choice of food, in order to positively influence the further course of the disease and prevent complications.

Aftercare

In most cases, those affected have only limited and only a few follow-up measures available for pancreas annulare. For this reason, the person affected should ideally see a doctor at the first symptoms and signs so that there are no complications or other complaints for the person concerned.

The sooner a doctor is consulted, the better the further course of the disease is usually, so that a doctor should be contacted as soon as the first signs and symptoms of the disease appear. Most of those affected are dependent on an operation. After such a procedure, the patient should rest and take care of his body, while maintaining strict bed rest and avoiding stressful activities.

In general, regular check-ups by a doctor after the procedure are very important in order to identify and treat further damage at an early stage. Further follow-up measures are not available to those affected with pancreas annulare. In most cases, this disease does not reduce the life expectancy of those affected.

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, with others only surgical interventions will help.

If vomiting is one of the symptoms, it is important for the patient to eat particularly carefully in order to avoid deficiencies. This is especially true for children whose development could otherwise be disturbed. We recommend several small meals a day, which should be easy to digest, but also rich in vitamins, minerals and fiber. A conscious diet not only has a positive influence on the symptoms, but can also compensate for any tendency to depression.Because constant nausea and vomiting trigger feelings of helplessness and powerlessness in some affected people.

In addition, patients are advised to have psychotherapeutic sessions. But various relaxation techniques also help to live with this rare disease. These include gentle sports like yoga, qigong and tai chi. Reiki, music therapy or EFT tapping therapy have also proven to be relieving. Progressive muscle relaxation according to Jacobson, which is even taught in adult education centers, is easy to learn and very effective. Meditations and breathing exercises are also good ways to reduce stress caused by illness. Exercise, especially outdoor exercise, also provides balance.