2022 Volume 72 Issue 1 Pages 23-29
Abstract:A 26-year-old woman was transported to the emergency ward of our hospital because of status epilepticus. Disturbance of consciousness turned out to be a symptom of hypoglycemia, and various modalities, including abdominal CT, detected two nodular lesions in the pancreatic body and one cystic lesion in the pancreatic tail. SASI test showed that the pancreatic head also had excessive insulin secretion, although no tumorous lesions were identified. She underwent laparo-assisted distal pancreatectomy with a preoperative diagnosis of multiple pancreatic insulinomas. A nodule of 5 mm was confirmed in the pancreatic head by intraoperative ultrasound, and the nodule was resected by enucleation. Intraoperative blood insulin and glucose monitoring showed a drop in blood insulin level and elevated blood glucose level after the total removal of four tumors. The histopathological diagnosis of all resected tumors was insulinoma. Pancreatic insulinoma presents symptoms of hypoglycemia even if the tumor is relatively small. On the other hand, preoperative diagnosis for small lesions or multiple lesions of insulinoma is often difficult. Preoperative SASI test and intraoperative monitoring for blood insulin and glucose will be quite beneficial for the complete removal of insulinomas, especially in cases with difficulty in determining tumor localization.
