Imaging pearls of the annular pancreas on antenatal scan and its diagnostic dilemma: A case report

Background: Annular pancreas is an uncommon cause of duodenal obstruction and rarely causes complete duodenal obstruction. Due to its rarity of identification in the antenatal period and overlapping imaging features with other causes of duodenal obstruction; it is often misdiagnosed. Case presentation: A 33-year-old primigravida came for routine antenatal ultrasonography at 28 weeks and 4 days of gestational age. On antenatal ultrasonography, dilated duodenum and stomach were seen giving a double bubble sign and a hyperechoic band surrounding the duodenum. Associated polyhydramnios was also present. Fetal MRI was also done. Postpartum ultrasonography demonstrated pancreatic tissue surrounding the duodenum. The upper gastrointestinal contrast study showed a non-passage of contrast beyond the second part of the duodenum. Due to symptoms of obstruction, the neonate was operated on, and the underlying cause was found to be the annular pancreas. Conclusion: Diagnosis of duodenal obstruction due to the annular pancreas is very important in the antenatal period to plan for appropriate therapeutic interventions after birth. A double bubble sign is seen due to various etiologies however the presence of a hyperechoic band in the antenatal ultrasound may point to the diagnosis of the annular pancreas.

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Gastroduodenal Emphysema with Portal Venous Air due to Congenital Duodenal Web in a Child: A Case Report and Review of Literature

Case Reports in Pediatrics ◽

10.1155/2020/9897208 ◽

2020 ◽

Vol 2020 ◽

pp. 1-5

Author(s):

Mihiri Chami Wettasinghe ◽

Shanthini Rosairo ◽

Samantha Kiriwattuduwa ◽

Nuwan Darshana Wickramasinghe

Keyword(s):

Duodenal Obstruction ◽

Gastric Wall ◽

Abdominal Distension ◽

Duodenal Wall ◽

Emergency Laparotomy ◽

Contrast Study ◽

Imaging Features ◽

Rare Presentation ◽

Duodenal Web ◽

Portal Venous Air

Congenital duodenal web causing proximal duodenal obstruction leading to gastroduodenal emphysema is a very rare presentation in infancy. Due to persistent  peristalsis against the duodenal membrane, there is progressive stretching of the duodenal web leading to windsock deformity. We describe a rare case of a child with gastroduodenal emphysema and portal venous air due to duodenal obstruction secondary to a duodenal web. An eighteen-month-old male child, who was under investigation for failure to thrive, presented with a history of persistent projectile vomiting and progressive abdominal distension for two days. The abdominal ultrasound scan revealed air within the portal vein and in the wall of the stomach. Plain X-ray abdomen confirmed the presence of gas in the gastric wall and in the proximal duodenal wall. Upper gastrointestinal contrast study revealed complete obstruction at the second part of the duodenum. The child underwent emergency laparotomy, which revealed a duodenal web as the cause of the duodenal obstruction. During the surgery, windsock deformity was noted. This case illustrates that although rare, proximal duodenal obstruction due to duodenal web may present in early childhood and that alarming imaging features such as gastric emphysema and portal venous air could be associated with benign conditions.

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CLINICAL CASE OF THE DUODENAL OBSTRUCTION THAT CAUSED BY AN ANNULAR PANCREAS IN THE NEWBORN

Neonatology surgery and perinatal medicine ◽

10.24061/2413-4260.iv.1.11.2014.19 ◽

2014 ◽

Vol 4 (1(11)) ◽

pp. 114-118

Author(s):

О.B. Bodnar

Keyword(s):

Duodenal Obstruction ◽

Clinical Case ◽

Annular Pancreas

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ANNULAR PANCREAS CAUSING DUODENAL OBSTRUCTION: A CASE REPORT

Journal of Evolution of Medical and Dental Sciences ◽

10.14260/jemds/2016/64 ◽

2016 ◽

Vol 5 (05) ◽

pp. 296-300

Author(s):

Swish Kumar Singh ◽

Dinesh Kumar Agrawal ◽

Suganita Suganita ◽

Singh G N ◽

Amar Kumar Singh

Keyword(s):

Case Report ◽

Duodenal Obstruction ◽

Annular Pancreas

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Intramural Duodenal Hematoma In 2-year Old Child

APSP Journal of Case Reports ◽

10.21699/ajcr.v9i3.42 ◽

2018 ◽

Vol 9 (3) ◽

pp. 18

Author(s):

Dayanand Hota ◽

Kamal Nain Rattan ◽

Ahmad Khursheed ◽

Manish Swami ◽

Harish Bhardwaj

Keyword(s):

Duodenal Obstruction ◽

Intramural Hematoma ◽

Abdominal Distension ◽

Rare Entity ◽

Diagnostic Dilemma ◽

X Ray ◽

Duodenal Hematoma ◽

High Degree ◽

High Intestinal Obstruction ◽

Head Of Pancreas

Background: Intramural hematoma of the duodenum is a rare cause of acquired duodenal obstruction. It is often a diagnostic dilemma and a high degree of suspicion is required to make an early and accurate diagnosis in children. Case Report: A 2-year-old child presented with bilious vomiting and abdominal distension. X-ray abdomen showed high intestinal obstruction. Ultrasound and CT scan abdomen gave suspicion of pancreatic pseudo-cyst near head of pancreas. At surgery, an intramural hematoma of the duodenum was found and drained. Conclusion: Intramural duodenal hematoma is a rare entity especially in children and should be considered in differential diagnosis of acquired duodenal obstruction.

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Diagnostic Dilemma of a Rare, Giant Retroperitoneal Schwannoma: A Case Report and Review of Literature

Case Reports in Oncological Medicine ◽

10.1155/2014/628538 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Mahendra Singh ◽

Lovekesh Kumar ◽

Rajkumar Chejara ◽

Om Prakash Prasad ◽

Yuvraj Kolhe ◽

...

Keyword(s):

Low Frequency ◽

Surgical Excision ◽

Abdominal Distension ◽

Exploratory Laparotomy ◽

Postoperative Recovery ◽

Cystic Mass ◽

Imaging Features ◽

Diagnostic Dilemma ◽

Complete Surgical Excision ◽

Retroperitoneal Schwannoma

Schwannoma is a benign tumour of peripheral nerve sheath. It usually arises from head, neck, and trunk. Retroperitoneal schwannoma is a rare entity, accounting for only 0.3–3% of total schwannomas. Majority of retroperitoneal schwannomas reported in literature have a diameter of 5 to 15 cm. Preoperative diagnosis is difficult due to low frequency, nonspecific clinical course, and nonspecific imaging features. Histology usually provides definitive diagnosis. Schwannomas are solitary, well-circumscribed, and noninvasive, so complete surgical excision provides good result. We report a case of a 23-year-old male, who presented with progressive abdominal distension and intermittent episodes of intestinal obstruction. CECT was suggestive of huge solid-cystic mass in abdominopelvic region. Image guided percutaneous aspiration revealed around 1 litre of frank pus and FNAC was suggestive of abscess. Exploratory laparotomy revealed a large 32 × 28 × 26 cm mass with solid and cystic components containing 1 litre of pus. Histological features of tumour were suggestive of benign schwannoma and immunohistochemistry for S-100 was positive. Postoperative recovery was uneventful. We report this case of a retroperitoneal schwannoma because of giant size, rare location, unusual presentation, and diagnostic dilemma.

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Unusual endophytic non-enhancing tumour in the renal pelvis: a diagnostic dilemma

BMJ Case Reports ◽

10.1136/bcr-2021-245037 ◽

2021 ◽

Vol 14 (9) ◽

pp. e245037

Author(s):

Murali Krishna ◽

Santosh Kumar ◽

Kalpesh Mahesh Parmar ◽

Venkatesh Dhana Sekaran

Keyword(s):

Renal Cell ◽

Cell Cancer ◽

Diagnostic Techniques ◽

Molecular Diagnostic ◽

Molecular Diagnostic Techniques ◽

Imaging Features ◽

Diagnostic Dilemma ◽

Upper Tract Urothelial Cancer ◽

Cell Variant ◽

Clear Cell Variant

Renal cell cancer (RCC) is incidentally detected on imaging in 50%–60% of cases. Among the RCCs, clear cell variant is most common and classically seen as heterogenous enhancing lesion on CT imaging. Hypoenhancing mass presents a diagnostic dilemma with differential diagnosis being urothelial carcinoma, fat poor angiomyolipoma, oncocytoma or rarer variants of RCC. Such cases require further evaluation in form of urine cytology or newer molecular diagnostic techniques. Here, we present a case of renal mass with minimal enhancement on CT scan and imaging features suggestive of upper tract urothelial cancer. Final histopathology revealed the mass to be chromophobe variant of renal cell carcinoma.

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Incidental Finding of Annular Pancreas in a Routine Cadaveric Dissection: Case Report

Journal of Morphological Sciences ◽

10.1055/s-0039-1696694 ◽

2019 ◽

Vol 36 (04) ◽

pp. 299-302

Author(s):

Mythraeyee Prasad ◽

Theresa Susan Kuriakose ◽

Sipra Rout

Keyword(s):

Congenital Anomaly ◽

Case Report ◽

Duodenal Obstruction ◽

Clinical Symptoms ◽

Incidental Finding ◽

Age Groups ◽

Annular Pancreas ◽

Present Case Report ◽

Rare Congenital Anomaly ◽

Variable Presentation

AbstractAnnular pancreas is a rare congenital anomaly that results from the malrotation of the ventral pancreatic bud. The presentation of annular pancreas varies: it can be asymptomatic or present clinical symptoms of duodenal obstruction that can affect all age groups, from newborns to adults. In the present case report, we describe a complete type of annular pancreas at the level of the second part of the duodenum, which was an incidental finding in a prosected specimen. This anomaly has significant clinical relevance to clinicians and radiologists due to its variable presentation. The embryological, clinical and radiological aspects of this congenital anomaly are discussed in detail in the present article.

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Delayed presentation of a congenital duodenal web managed successfully with incision of web

BMJ Case Reports ◽

10.1136/bcr-2020-237307 ◽

2020 ◽

Vol 13 (12) ◽

pp. e237307

Author(s):

Mahendra Kumar Jangid ◽

Reyaz Ahmad ◽

Sujeet Pandre

Keyword(s):

Abdominal Pain ◽

Duodenal Obstruction ◽

Accurate Diagnosis ◽

Unusual Presentation ◽

Contrast Study ◽

Delayed Presentation ◽

History Of ◽

Duodenal Web ◽

High Index Of Suspicion ◽

The Web

One of the causes of congenital incomplete duodenal obstruction is the presence of congenital duodenal web with fenestration. This condition requires a high index of suspicion for an early and accurate diagnosis. We present an unusual presentation of duodenal web in a 6-year-old girl who presented with a 3-year history of cyclical and seasonal vomiting and abdominal pain. The diagnosis of congenital duodenal web with fenestration was made on contrast study and endoscopy and was treated surgically by incision of the web.

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