Abstract
A malignant duodenal submucosal gastrinoma in a 37-year-old man is reported. Since 1981 he has had three times gastrectomies and one operation for lieus. In May 1989, hypergastrinemia (602 pg/dl) was noticed by a doctor and he was sent to our hospital. The diagnosis was Zollinger-Ellison syndrome because of a positive secretin test. We performed the selective arterial secretin injection test for locating gastrinomas. Increase of the hepatic venous IRGs 40 seconds after bolus injection of 30 units secretin into the gastroduodenal artery and superior mesenteric artery was 370 pg/dl and 150 pg/dl, respectively. But the increase was not meaningful after the injection of secretin into the splenic artery. Thus gastrinoma was diagnosed as being located in the pancreaticoduodenal region. At the operation, the tumor (8×9mm) was found in the submucosal layer of the descending duodenum, not in the pancreatic head, and was resected. An intraoperative secretin test by the rapid gastrin immunoassay method after the lymph node dissection around the pancreaticoduodenal region was negative, which led us to conclude that the operation was curative. The patient is alive with no recurrence 2 years and 10 months after the last operation.
