Annular pancreas associated with duodenal obstruction.

DESCRIPTION A preterm neonate weighing 1360 g was born at 33+2 weeks’ gestation with severe polyhydramnios. She was transferred, directly after delivery, to our neonatal intensive care unit presenting with distended upper abdomen and vomiting. A plain film of the abdomen (figure 1) was performed with the suspicion of duodenal atresia and showed a markedly distended stomach (S) and proximal duodenum (D) with no evidence of bowel gas distal to the duodenum. This finding, known as double bubble sign, is pathognomonic for a number of pathologies that cause duodenal obstruction, for example, duodenal web, duodenal atresia, midgut volvulus or annular pancreas. At laparatomy (figure 2) the stomach (black arrowheads) and the duodenum were markedly dilated due to a complete annular band of pancreatic tissue that surrounded and constricted the second part of the duodenum (white arrows); distal to this site, the jejunum (black arrows)