Annular pancreas and cirrhosis
Abdominal pain for investigation.
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The pancreas enhances normally and there are no masses or cysts. Pancreatic tissue encircles the second part of the duodenum. It is otherwise normal in size and are no calcifications. The portal and splenic veins enhance normally. The splenic artery is unremarkable.
Large volume ascites again demonstrated. The liver is small with a nodular surface in keeping with cirrhosis. Perioesophageal varices noted.
An annular pancreas can be difficult to identify if care is not taken when assessing the pancreatic head. In most instances it is an asymptomatic incidental finding, as it likely the cases here. This patient has a long history of alcohol abuse and has cirrhosis.
Case courtesy of A/Prof Damien Stella, Royal Melbourne Hospital.