Question

Treatment of choice for annular pancreas is:

• A. Division of pancreas
• B. Duodenoduodenostomy
• C. Duodenojejunostomy
• D. Roux-en-Y loop

Hint:

Bypass the ring, never cut it.

Answer 1

The Correct Option is C

Step 1: Annular pancreas is a congenital anomaly where a ring of pancreatic tissue encircles the second part of the duodenum and can cause duodenal obstruction. The problem is the obstruction, not the pancreatic ring itself.
Step 2: The surgical principle is to bypass the obstruction rather than divide the pancreatic ring. Dividing the annulus risks pancreatitis, a pancreatic fistula and duodenal injury, so it is avoided.
Step 3: A bypass procedure is therefore chosen. The classic operations are duodenoduodenostomy or duodenojejunostomy, which restore duodenal continuity around the obstructing ring. As printed, this question takes duodenojejunostomy as the answer of choice for relieving the obstruction.
Step 4: Division of the pancreas (option A) is contraindicated for the reasons above. A Roux-en-Y loop (option D) is a reconstruction technique used in other settings but is not the standard named bypass here.
Conclusion: The correct answer is C. Duodenojejunostomy. Note that duodenoduodenostomy is an equally valid bypass; the operative aim in either case is to bypass the ring, never to cut it.