ACCESORY ANULAR PANCREAS CAUSING GASTRIC OUTLET OBSTRUCTION

A 62-year-old man presented with findings of chronic iron deficiency anemia. Symptoms included intermittent rectal bleeding alternated with black stools.

History

Physical exam remarkable for cachectic man with more than 20 pounds weight loss. No lymphadenopathy.

Findings 

Upper and lower endoscopy remarkable for severe esophagitis. CT with findings of duplicated pancreas, with annular configuration of the duplication causing gastric outlet obstruction.

CT Axial

MRI confirmed tissue arising ventrally from the pancreatic body, with typical pancreatic cobblestoning. Isointense to the pancreatic parenchyma in all sequences.

MRI Axial

The antroduodenum was encircled demonstrating abundant intraluminal ingested material admixed with fluid throughout stomach. No peripancreatic inflammatory changes or fluid collections. No lymphadenopathy was identified.

Treatment

Patient was treated symptomatically. Iron supplement and MTV were added to therapy. Marked increased in HGB (From 7 to 12 G/DL with almost normal MCV). CMP without significant lytes disturbance.

Hiram Ortega-Cruz, MD, is a gastroenterology fellow, VA Caribbean Health Care System (VACHS), San Juan , PR.

Eduardo Acosta-Pumarejo, MD is on the radiology staff, VACHS, San Juan , PR.