Effective surgical management of gastric outlet obstruction symptoms caused by annular pancreas in an adult female: A case report.

INTRODUCTION: Annular pancreas (AP) is a rare condition that usually is not associated with symptoms in adults. However, in some patients, AP may cause non-specific symptoms such as abdominal pain and vomiting, making its diagnosis challenging. The current case report presents a challenging diagnosis of an AP case and surgical management of it by performing duodenoduodenostomy. CASE PRESENTATION: A 47-year-old female presented with chronic abdominal pain and vomiting after meals. The examination using CT showed a complete ring of pancreatic tissue encircling the descending part of the duodenum, confirming the diagnosis of AP. Therefore, the patient underwent duodenoduodenostomy, in which the obstruction was bypassed. CLINICAL DISCUSSION: AP is a rare condition characterized by a band of pancreatic tissue that encircles the second part of the duodenum. Most cases of AP in adults remain asymptomatic. However, when AP is symptomatic, it is associated with vague abdominal symptoms. The primary management of symptomatic AP in adults involves surgical bypass of the annulus through performing gastrojejunostomy or duodenojejunostomy. While duodenoduodenostomy is less favorable, we opted for it due to the limitation of the obstruction to a specific segment of the duodenum. CONCLUSION: This case underscores the importance of considering AP as a potential cause in the differential diagnosis of vague and persistent gastrointestinal symptoms. Moreover, most studies concerning the management of AP have consisted of case reports or small case series. This emphasizes the need for further studies to enhance our understanding of the most appropriate approach for managing each case of AP.

Pancreaticoduodenectomy in a patient with a rare celiac trunk and hepatic artery anomaly, a case report from Syria.

Pancreaticoduodenectomy is still one of the biggest and high complicated surgeries. It still has high morbidity and mortality rates. liver receives its blood supply from one hepatic artery a branch of the celiac trunk However variations of hepatic and celiac trunk are not rare. We present a case of a 60-year-old patient who underwent pancreaticoduodenectomy for ampulla tumor in which there were some rear anomalies. Angiographic CT after procedure confirmed the absence of celiac trunk, the absence of left gastric, the splenic artery arising from aorta directly and common hepatic artery arising from superior mesenteric artery. These anomalies are not considered contraindication and should not be. with good surgical experience the procedure may be done safely giving the patient his last choice to fight the disease.

Circulating Toxoplasma gondii-specific antibody-secreting cells in patients with congenital toxoplasmosis.

Patients with congenital toxoplasmosis occasionally show rises in serum antibodies to Toxoplasma gondii (serological rebound), but the underlying cause remains unclear. The acute or chronic presence of available antigen often causes the appearance, in the peripheral blood, of cells actively secreting specific antibody. We have evaluated the capacity of circulating blood cells from 91 children born to T. gondii-infected mothers to actively synthesize anti-T. gondii antibodies according to their serological status. Supernatants from 7-day cultures of peripheral blood mononuclear cells were evaluated for antibody by cytofluorimetry. Only 1 of 49 subjects with low and stable serum antibody titers produced specific antibodies on cultures, while 9 of 22 subjects with recent rebound were positive. One of the positive children alone showed clinical signs of parasite activity. These observations suggest that rebound may be associated with production of available parasite antigens, possibly associated with reactivation. Differentiation from other causes, such as polyclonal B cell stimulation, would improve our ability to detect clinically significant reactivation and to prevent complications.