|Year : 2016 | Volume
| Issue : 1 | Page : 155-156
Crocodile jaw sign
Brij Sharma1, Sujeet Raina2, Neetu Sharma3
1 Department of Gastroenterology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
2 Department of Medicine, Dr. Rajendra Prasad Govt. Medical College, Tanda, Kangra, Himachal Pradesh, India
3 Department of Physiology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
|Date of Web Publication||2-Jun-2016|
C-15, Type-V Quarters, Dr. Rajendra Prasad Govt. Medical College Campus, Tanda, Kangra - 176 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
This teaching image highlights the CT abdominal imaging finding of 'crocodile jaw sign' which should raise concern about the presence of an incomplete annular pancreas which causes partial encasement of the duodenum.
Keywords: Annular pancreas, CT, crocodile jaw sign
|How to cite this article:|
Sharma B, Raina S, Sharma N. Crocodile jaw sign. Arch Med Health Sci 2016;4:155-6
A 23-year-old female was attended in the gastroenterology outpatient department with recurrent vomiting for the last 1-year. Vomitus contained stale food material. Clinical examination and biochemical investigations were normal. An upper gastrointestinal endoscopy showed luminal narrowing in the second part of the duodenum due to external compression [Figure 1]A. Computed tomography (CT) abdomen revealed crocodile jaw morphology of the pancreatic head [Figure 1]B. The patient underwent gastrojejunostomy and did not experience vomiting episodes during the follow-up.
|Figure 1: (A) Esophagogastroduodenoscopy showing luminal narrowing of D2 due to extrinsic compression (B) Axial contrast-enhanced computed tomography of the abdomen reveals the duodenum (D) being partially encased by the head of pancreas (P) which exhibits a crocodile jaw appearance. Dilated stomach (S) also seen|
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Annular pancreas is an uncommon congenital anomaly and results from the failure of the ventral bud to rotate with the duodenum, resulting in the envelopment of the duodenum. It can cause abdominal pain, postprandial fullness, vomiting, gastrointestinal bleed from peptic ulcers, duodenal obstruction, pancreatitis, or may be asymptomatic for life. The annular pancreas can either be complete or incomplete. In complete, the pancreatic parenchyma is seen to completely surround the second part of the duodenum. While as in incomplete, the pancreatic tissue does not surround the duodenum completely, giving a “crocodile jaw” appearance. The crocodile jaw configuration of the pancreatic head represents an extension of pancreatic tissue anterior and posterior to the duodenum on CT imaging and is highly suggestive of the presence of annular pancreas.
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| References|| |
Sandrasegaran K, Patel A, Fogel EL, Zyromski NJ, Pitt HA. Annular pancreas in adults. AJR Am J Roentgenol 2009;193: 455-60.