## **Core Concept**
The annular pancreas is a rare congenital anomaly where pancreatic tissue surrounds the second part of the duodenum, potentially causing intestinal obstruction. The treatment approach depends on the presence and severity of symptoms.

## **Why the Correct Answer is Right**
The correct answer involves **duodeno-duodenostomy**, a surgical procedure that creates a bypass around the obstructed segment of the duodenum. This approach is favored because it is less invasive and can effectively relieve the obstruction caused by the annular pancreas, while preserving the pancreatic tissue and its function.

## **Why Each Wrong Option is Incorrect**
* **Option A:** This option is incorrect because simple **pancreatico-duodenectomy (Whipple procedure)** is a more extensive surgery typically reserved for pancreatic cancer or severe pancreatic disease, not a first-line treatment for annular pancreas.
* **Option B:** **Pyloric exclusion** is not a standard treatment for annular pancreas. This procedure might be considered in certain cases of duodenal injury or disease but is not directly relevant to treating annular pancreas.
* **Option C:** This option is incorrect as **gastrojejunostomy** might provide temporary relief but is not a definitive treatment for annular pancreas and can lead to complications like dumping syndrome.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that the management of annular pancreas is primarily surgical when symptomatic, and **duodeno-duodenostomy** is often considered the procedure of choice for relieving duodenal obstruction while preserving pancreatic function.

## **Correct Answer:** D. duodeno-duodenostomy.