Annular pancreas

Annular pancreas is a problem present at birth (congenital defect). Symptoms occur when the ring of pancreas tissue squeezes and narrows the small intestine so that food cannot pass easily or at all.

Newborns may have symptoms of complete blockage of the intestine. However, up to one half of people with this condition do not have symptoms until adulthood. There are also cases that are not detected because the symptoms are mild.

Conditions that may be associated with annular pancreas include:

• Down syndrome
• Excess amniotic fluid during pregnancy (polyhydramnios)
• Other congenital gastrointestinal problems
• Pancreatitis

Newborns may not feed well. They may spit up more than normal, not drink enough breast milk or formula, and cry.

Adult symptoms may include:

• Abdominal pain
• Fullness after eating
• Nausea or vomiting

Tests include:

• Abdominal ultrasound
• Abdominal x-ray
• Abdominal CT scan
• Upper GI and small bowel series

Treatment most often involves surgery to bypass the blocked part of the duodenum.

The outcome is most often good with surgery. Adults with an annular pancreas are at increased risk for pancreatic or biliary tract cancer.

Complications may include:

• Obstructive jaundice
• Pancreatic cancer
• Pancreatitis (inflammation of the pancreas)
• Peptic ulcer
• Perforation (tearing a hole) of the intestine due to obstruction
• Peritonitis

Contact your health care provider if you or your child has any symptoms of annular pancreas.

Bales CB, Liacouras CA. Intestinal atresia, stenosis, and malrotation. In: Kliegman RM, St. Geme JW, Blum NJ, et al, eds. Nelson Textbook of Pediatrics. 22nd ed. Philadelphia, PA: Elsevier; 2025:chap 376.

Mehta MS, Barth BA, Husain SZ. Anatomy, histology, embryology, and developmental anomalies of the pancreas. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 55.

Semrin MG. Anatomy, histology, and developmental anomalies of the stomach and duodenum. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology/Diagnosis/Management. 11th ed. Philadelphia, PA: Elsevier; 2021:chap 49.

Updated by: Todd Eisner, MD, Private practice specializing in Gastroenterology in Boca Raton and Delray Beach, Florida at Gastroenterology Consultants of Boca Raton. Affiliate Assistant Professor, Florida Atlantic University School of Medicine. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.