Annular pancreas causing duodenal obstruction in an adult

A 35-year-old man was admitted following daily vomiting for 2 weeks. He reported bouts of unexplained vomiting over the preceding 10 years. Gastroscopy showed obstruction in the second part of the duodenum with normal mucosa on biopsy (figure 1). CT demonstrated dilation of the first part of the duodenum caused by narrowing of the second part (figure 2). There was no pancreatic mass. At laparotomy, a ring of pancreatic tissue was found encircling the second part of the duodenum causing obstruction (figure 3). This is …