INTRODUCTION: The @entity20426 is a @entity154 in which pancreatic tissue partially or completely surrounds the second portion of the duodenum. Its often located above of papilla of Vater (85%), rarely below (15%). This pancreatic tissue is often easily dissociable to the duodenum but there is same cases where it the tissue is into the muscolaris wall of the duodenum. MATERIAL AND METHODS: We describe three case of @entity20426 hospitalized in our facility between January 2004 and January 2009. There were 2 male 65 and 69 years old respectively and 1 female of 60 years old, presented complaining of repeated episodes of mild @entity158 . Laboratory tests (including @entity5 markers), a direct abdomen X-ray with enema, EGDS and total body CT scan were performed to study to better define the diagnosis. EUS showed the presence of tissue infiltrating the muscle layer all around the first part of duodenum. Biopsies performed found the presence of pancreatic tissue with focal areas of @entity420 . Subtotal gastrectomy with Roux was performed. The histological examinations shows an @entity20426 of D1 with multiple focal area of @entity420 . (T1aN0M0). RESULTS: We performed a follow up at 5 years. One @entity1 died after 36 months for cardiovascular hit. Two @entity1 , one male and one female, was 5-years disease-free. DISCUSSION: @entity20426 is an uncommon @entity154 which usually presents itself in @entity1 and newborn. Rarely it can present in late adult life with wide range of clinical severities thereby making its diagnosis difficult. Pre-operative diagnosis is often difficult. CT scan can illustrate the pancreatic tissue encircling the duodenum. ERCP and MRCP are useful in outlining the annular pancreatic duct. Surgery still remains necessary to confirm diagnosis and bypassing the obstructed segment.

" XXXX in anular pancreas".

@entity1 :: ('9606', 'Species') :: ['patients', 'infants'] @entity154 :: ('MESH:D000013', 'Disease') :: ['congenital anomaly'] @entity20426 :: ('MESH:C536376', 'Disease') :: ['Annular pancreas', 'annular pancreas'] @entity5 :: ('MESH:D009369', 'Disease') :: ['tumor'] @entity158 :: ('MESH:D010146', 'Disease') :: ['epigastric pain'] @entity420 :: ('MESH:D000230', 'Disease') :: ['adenocarcinoma']
@entity420 :: (MESH:D000230,Disease) :: ['Ductal adenocarcinoma']
