A 55-year-old woman was admitted to our institution with a 2-week history of persistent postprandial nausea and vomiting. CT showed a fluid-filled stomach, a mass in the pancreatic head with liver metastases, and pancreatic parenchyma encircling the descending part of the duodenum (A, B). MRCP demonstrated a ring-shaped pancreatic duct encircling the descending duodenum, and EUS confirmed a hypoechoic mass in the pancreatic head invading the duodenal lumen. EUS-FNA confirmed annular pancreas and coexisting adenocarcinoma. Because of the liver metastasis, surgical treatment was not indicated, and we tried to perform duodenal stent placement. On duodenoscopy, massive distention of the stomach and stenosis of the descending part of the duodenum were observed (C). Because of a pinhole-like stenosis, we could not pass the endoscope.
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