Gastric outlet obstruction secondary to annular pancreas with signs of complicated acute pancreatitis and duodenal perforation

Abstract

We present the case of a male patient with a history of compensated advanced chronic liver disease secondary to hepatitis C virus infection and clinical signs of portal hypertension, who required three hospital admissions due to gastric outlet obstruction caused by duodenal stenosis secondary to acute pancreatitis in the setting of an annular pancreas. The patient had remained asymptomatic until the first episode of acute pancreatitis. Initial management was conservative, including symptomatic treatment and total parenteral nutrition until resolution of the inflammatory process.

He later presented with recurrent vomiting and abdominal pain. Imaging studies revealed multiple intra-abdominal fluid collections and duodenal perforation as complications of the previous episode. Given the severity and unfavorable clinical course, surgical management was indicated once the acute episode subsided. Portal hypertension significantly influenced therapeutic decision-making, and the surgical approach was adapted to select the safest technique for this high-risk patient.

Keywords: annular pancreas, gastric outlet obstruction, collections.