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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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Year : 2021  |  Volume : 26  |  Issue : 5  |  Page : 360-361
 

Biliary reflux in annular pancreas in upper gastrointestinal contrast study


Department of Pediatric Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India

Date of Submission17-Jan-2021
Date of Decision01-Apr-2021
Date of Acceptance21-Apr-2021
Date of Web Publication16-Sep-2021

Correspondence Address:
Dr. Enono Yhoshu
Department of Pediatric Surgery, All India Institute of Medical Sciences, 6th Floor A Block, Veerbhadra Road, Rishikesh- 249 203, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaps.JIAPS_7_21

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How to cite this article:
Ayesha Parveen A G, Yhoshu E, Chaudhary G, Balija SS. Biliary reflux in annular pancreas in upper gastrointestinal contrast study. J Indian Assoc Pediatr Surg 2021;26:360-1

How to cite this URL:
Ayesha Parveen A G, Yhoshu E, Chaudhary G, Balija SS. Biliary reflux in annular pancreas in upper gastrointestinal contrast study. J Indian Assoc Pediatr Surg [serial online] 2021 [cited 2022 Jul 6];26:360-1. Available from: https://www.jiaps.com/text.asp?2021/26/5/360/326073




An 8-month-male presented with recurrent nonbilious vomiting after feeding for 3 months. On examination, he was pale, lethargic and dehydrated and his abdomen was soft. Ultrasonography of the abdomen showed distended stomach and duodenum. Plain X-ray abdomen showed distended stomach with the paucity of distal bowel gas. An upper gastrointestinal contrast study (UGICS) showed distended stomach along with the first part of duodenum in the initial immediate film. Follow-up film at 15 min showed partial obstruction at the 2nd part of the duodenum with reflux of contrast into the biliary channel [Figure 1]. The patient underwent exploratory laparotomy wherein annular pancreas [Figure 2] was found and he underwent a Kimura's Duodenoduodenostomy. Postoperatively, he recovered well and in follow-up of 10 months, the patient is feeding well and has gained weight.
Figure 1: Upper gastrointestinal contrast study at 15 min showing enlarged stomach and first part duodenum with reflux of contrast into the biliary system (arrow) and passage of contrast to distal bowel

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Figure 2: Intraoperative picture showing dilated first part duodenum, annular pancreas (arrow), and normal second part duodenum

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An UGICS in the annular pancreas shows enlarged stomach and the first part of the duodenum with a smooth or tapered narrowing in the second part of the duodenum with the distal passage of contrast in the cases which have partial obstruction.[1] In the cases with postampullary annular pancreas, the contrast can also reflux up the biliopancreatic system. This has been rarely reported. Downing et al. reported a case of Annular Pancreas with malrotation associated with choledochal cyst wherein the UGICS done at neonatal age showed duodenal obstruction with reflux into the dilated biliary tree and a choledochal cyst. The child underwent Ladd's procedure with duodenoduodenostomy on day 4 of life.[2] Though very rarely found, reflux filling of the biliopancreatic system in UGICS in Annular Pancreas may suggest a postampullary location of the obstruction.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Gupta P, Debi U, Sinha SK, Prasad KK. Upper gastrointestinal barium evaluation of duodenal pathology: A pictorial review. World J Radiol 2014;6:613-8.  Back to cited text no. 1
    
2.
Downing B, Bader MY, Morello FP, Kylat RI. Unique Case of Congenital Duodenal Atresia and a Choledochal Cyst and the Hypothesis of Their Embryological Evolution. Children (Basel) 2020;7:99. doi: 10.3390/children7080099.  Back to cited text no. 2
    


    Figures

  [Figure 1], [Figure 2]



 

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