Sestre Milosrdnice University hospital and Institute of Clinical Medical Research
Abstract
Annular pancreas is a rare embryonal abnormality. Its manifestation in adulthood is often pinpointed with a substantial delay, which is most often attributed to pancreatitis, biliary pathology or dyspepsia. We present a case of a 28-year-old woman who had exacerbating symptoms of high bowel obstruction from 20th week of pregnancy, progressing after premature delivery. Diagnostic work-up revealed partial annular pancreas compressing the duodenum. Despite attempts of conservative treatment, her state deteriorated to such an extent that surgery was indicated and gastrojejunal bypass created. Her postoperative recovery was uneventful. In cases in which symptoms of high bowel obstruction in pregnancy persist and prostration occurs, we suggest close monitoring and a more thorough diagnostic approach. The question remains whether annular pancreas presents a cause of pathologic findings, a cofactor, or a mere accidental diagnosis in the development of superposed pathologies.Anularna gušterača je rijetka embrijska anomalija. Simptomi kojima se javlja u odrasloj dobi pripisuju se pankreatitisu, bilijarnoj patologiji ili dispepsiji, pa se do dijagnoze dolazi sa znatnim vremenskim odmakom. Prikazujemo slučaj 28-godišnje trudnice sa simptomima opstrukcije dvanaesnika koji su se javili od 20. tjedna trudnoće i pogoršali se nakon prijevremenog poroda. Obradom je postavljena sumnja na djelomičnu anularnu gušteraču koja pritišće dvanaesnik. Unatoč konzervativnom liječenju dolazi do pogoršanja općeg stanja i indicira se operacijski zahvat. Postavljena je gastrojejunalna anastomoza. Poslijeoperacijski tijek je protekao bez komplikacija. Kod dugotrajnih simptoma opstrukcije dvanaesnika u trudnoći uz pogoršanje općeg stanja predlaže se pomnije praćenje bolesnica i detaljniji dijagnostički postupak. Ostaje neriješeno pitanje je li anularna gušterača u ovom slučaju bila jedini uzrok, supostojeći čimbenik ili tek slučajan nalaz
