Portal Annular Pancreas: Prevalence and Surgical Importance.

PAP, though often asymptomatic, is a critical anatomical variant that carries significant implications for pancreatic resections and outcomes. While its reported prevalence varies, our study suggests that it is not as rare as once believed. Under-recognition of PAP can contribute to higher rates of postoperative pancreatic fistula. The PAP which requires pancreatic resections can be best managed by preoperative identification in the image, meticulous anastomosis depending on the location, stapler resection of annular pancreas, complete excision of annular part, properly placed drain and postoperative vigilance for pancreatic fistula. Radiologists and surgeons must maintain a high index of suspicion and collaborate closely during preoperative evaluations to reduce intraoperative surprises and optimize surgical outcomes.