PMC10117017_01
Chest and abdominal X-ray showed marked gaseous distension of the stomach (S) and proximal duodenum. Bowel gas is seen beyond the proximal duodenum
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F1
The erect abdominal radiography showed a very dilated stomach [Figure 1].
Double-contrast barium radiography showed stenosis of the second duodenum (D2) (yellow arrow) associated with proximal dilation of the duodenal bulb (D1) and stomach (S), classically known as the 'double bubble' sign. The barium contrast passes beyond the duodenal bulb (star)
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F2
Upper gastrointestinal tract contrast study demonstrated grossly dilated stomach and duodenum with delayed passage of contrast distally suggestive of partial duodenal obstruction [Figure 2].
Axial non-contrast computed tomography of the abdomen showed a ring of pancreatic tissue that completely encircles the second duodenum (yellow arrows) leading to the diagnosis of annular pancreas with gastric outlet obstruction (green arrow)
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F3
AP [Figure 3]. After fluid resuscitation and correction of renal function and electrolyte disorders, a right upper abdominal transverse laparotomy was performed.
An intraoperative view showing the annular pancreas as a ring surrounding the second part of the duodenum
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F4
The typical aspect of AP was noted and a conventional diamond-shaped duodenoduodenostomy was achieved [Figures 4 and 5].
Intraoperative view showing the final appearance of duodenoduodenostomy
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F5
The typical aspect of AP was noted and a conventional diamond-shaped duodenoduodenostomy was achieved [Figures 4 and 5].