Congenital Malformation: Annular Pancreas

Annular pancreas is a rare congenital disorder, present at birth in which a ring of pancreatic tissue surrounds the duodenum (first part of small intestine).  The normal pancreas is located next to the duodenum and connects to it by a duct. The ring of pancreatic tissue squeezes the duodenum blocking food from passing through the intestine and impairing digestion. Conditions that may be associated with annular pancreas include:

  • Down syndrome​

  • Other congenital gastrointestinal problems

  • Pancreatitis

  • Excess amniotic fluid during pregnancy (polyhydramnios)

The disorder is more prevalent in males and only one in twenty thousand new borns is affected by it.​​

In half of cases, symptoms may not be present until adulthood as the ring may be so small that it does not obstruct the duodenum. In the other half the symptoms may arise as the tissue constricts the small intestine. 

Symptoms in adults include:

  • Fullness after eating

  • Nausea and vomiting

Symptoms in infants include:

  • Crying

  • Spitting up more milk than normal

  • Not drinking enough formula or breast milk ​

If you notice the above mentioned symptoms in your new born or yourself, make an appointment with our highly trained doctors in Family Medicine​ or  Internal Medicine Service Line​ at the Aga Khan University Hospital
Your time with your doctor maybe limited, so make sure to prepare for your visit beforehand. Here are some tips to help get you started.​ ​

Your doctor will take a full medical history and ask questions about any symptoms. The following series of tests may be requested:

  • CT scan (computed tomography) in which a series of detailed images, of the body, are taken by a computer. This is done to see the structure of the pancreas.

  • Abdominal ultrasound, in which sound waves and a sensor is used to detect any abnormalities in the pancreatic structure. Sound waves are sent towards the pancreas by a handheld device that is moved across the abdomen which creates an image on the computer to be studied by the doctor.

  • X-ray in which an image is created on the computer by the help of X-rays

  • Upper GI and small bowel series in which you will get an injection which slows down the muscle movement in small intestine. Then you may be asked to drink a milk-shake like beverage which contains barium before being exposed to X-rays. Fluoroscopy is a special X-ray method in which the movement of the barium is tracked down the oesophagus, through the stomach into the small intestine. You may be asked to sit and stand in various positions while the pictures are being taken. The test determines if there is a malformation in the oesophagus, stomach or small intestine and if they are functioning properly.​

The aim of the treatment provided by your doctor is to remove the blockage so that the small intestine can function normally. This can be done through surgery by bypassing the obstructed segment of the duodenum. The pancreatic tissue forming the ring cannot be removed as this may cause damage to the pancreas. Surgical options for bypass include:

  • Gastrojejunostomy in which a new passage is made between the stomach and the jejunum (a part of the small intestine between duodenum and ileum).

  • Duodenojejunostomy in which a new passage is created between the duodenum and jejunum.

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the 'Important Numbers' section on the website homepage.

The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments' costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the 'Important Numbers' section on the website homepage.

Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the 'Important Numbers' section on the website homepage.




The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.