Secretin-Stimulated MRCP Diagnosis of Annular Pancreas

Establishing the diagnosis of annular pancreas is often delayed. We describe a case summary of a gentleman 86 years of age with a long history of vomiting in whom the diagnosis of annular pancreas was delayed for over three (perhaps nine) years, magnetic resonance pancreatography after secretin stimulation demonstrated the duct of annular pancreas, and symptoms resolved after operative treatment (initially gastrojejunostomy and later converted to a Roux-en-Y gastrojejunostomy due to persisting severe gastric retention). Annular pancreas is one of the more common congenital anomalies of the pancreas. Most symptomatic patients are discovered early in life. A review of the published literature on annular pancreas revealed this to be the oldest reported patient and the first report of the use of secretin – stimulated MRCP to diagnose annular pancreas.