Figure 1: Endoscopic retrograde cholangioscopy
In the distal hepatocholedochal duct there seems to be a contrast media sparing concrement or adenoma (red arrow).
FIGURE 2
Figure 2: CT-Scan of the duodenal region
The red arrow points to a suspicious tissue surrounding and pressing in the pars decendens duodeni ("crocodile jaw"). The previously implantet stent (green arrow) enters duodenum aboral to the ring-like tissue.
FIGURE 3
Figure 3: Intraoperative Picture of annular pancreas The descendent part of duodenum is totally encircled with pancreatic tissue (green arrow). Ampulla of vater has not been detectable.
FIGURE 4
Figure 4: Photography of the ampulla of vater
In the center of the duodenotomy the ampulla has been exposed (green arrow). The adenoma is not shown.
FIGURE 5
Figure 5: Treatment scheme for annular pancreas patients
Figures at a glance