Abstract
An urgent omentoplasty was performed for perforation of duodenal ulcers in a 54-year-old woman who was undergoing maintenance dialysis for chronic renal failure. However, bleeding from multiple ulcers and refractory diarrhea persisted. Proton pump inhibitor therapy was problematic because it caused pancytopenia in this patient. Contrast-enhanced computed tomography showed multiple nodules around the duodenum, and a selective arterial secretagogue injection test demonstrated a gastrinoma in the gastroduodenal artery area. Therefore, octreotide administration was started, and tumor reduction and bleeding control were achieved. A subtotal stomach-preserving pancreaticoduodenectomy was performed. The resected specimen showed a 4.5-mm, duodenal gastrinoma and a metastatic lymph node. After the procedure, the patient developed peritonitis due to leakage of the gastrojejunal anastomosis, but she recovered with intensive care. Duodenal gastrinomas are extremely rare in dialysis patients. Octreotide was effective in its perioperative management.
